Хто я як акушерка?

Існують різні види акушерок, і це добре, якщо ми чесні перед собою та нашими клієнтами щодо того, ким ми є та своїх можливостей.

Частиною навчання є вивчення того, ким я є як акушерка, примірка та/або спостереження за різними типами акушерок і акушерства. Це передбачає постійну оцінку мого стосунку з медикалізацією багатьох життєвих процесів.

Сьогодні я змогла висловити частину своїх особистих цінностей як акушерки.

Я хочу бути акушеркою, яка розвиває наш зв’язок із Богом і Його творінням, а також шанує медичні методи лікування, розроблені завдяки Божій укріплення для людства.

Who am I as a midwife?

There are all kinds of midwives, and that’s a good thing as long as we’re honest with ourselves and our clients about who we are and our capabilities. Part of schooling is exploring who I am as a midwife, trying on and/or observing different types of midwives and midwifery.

This involves a constant evaluating my relationship with the medicalization of so many life processes.

So today I was able to express a part of my personal values as a budding midwife.

A midwifery that cultivates and preserves our connection to God and His creation yet honors the treatments of medicine that God has enabled men to develop.

Newborn crying and colic

This post is based off of a midwifery school assignment.

Crying is a communication tool, one of the few that babies have. It is vital to understand that newborns and babies do not have the rational capacity to perform manipulative behavior; train your mind and heart to accept their crying for what it is, a cry.

For most infants, crying is normal and is fairly easy to soothe. Not so long ago, your baby was warm, hugged and held (by the womb), hearing the soothing sounds of his mother’s heart beat and whooshing water around his ears, muted voices. He never experienced hunger or uncomfortable diapers or clothing, injections, loud noises, feeling cold, alone, or even something as simple as an itch somewhere on the skin.

They are also developing awareness and brain development at a stunningly rapid pace. This causes its own good and bad stresses for the baby.

Let’s think of some common reasons a baby might cry. He feels hunger (breastmilk digests quickly), his diaper is dirty, he’s tired and can’t control his limb movement; he instinctively understands that he should not be alone and needs to be held, a loud noise or a jostle scares him, he has an earache or other sickness that causes pain.

With observation, parents learn to differentiate why their baby is crying—one type of cry is for hunger, another for sickness, another for fear. It’s helpful to learn the pre-crying cues that baby is hungry—turning head to the side, sucking on fist, and mouthing sucking motions are common hunger signals. Responding quickly to babies’ cries can minimize crying and facilitate good communication skills between the parent and their child that can last a lifetime.

Holding your baby actually induces a state of calm in the baby. His heartbeat automatically slows down and it physically relaxes his muscles and nervous system.

We’ll discuss colic below, but first, here are cries and conditions that should be immediately evaluated by a doctor:  

  • A high-pitched, catlike wail (especially when the baby is also jaundiced)
  • Any strangely high-pitched or low-pitched crying
  • Persistently weak crying
  • Crying that doesn’t stop for 2 hours no matter how you try to soothe, feed, or comfort
  • Crying when you hold, touch or move the baby
  • If your baby looks or acts in a way that is abnormal
  • If your baby has a temperature over 38.0
  • If your baby won’t feed (or only very little) for 8 hours or more
  • If you baby vomits in a way that is unusual, persistent, or projectile
  • If the baby has a bulging or swollen soft spot or a swollen groin area

These can be emergency situations. When there are crying questions that are non-emergency, check the baby’s weight gain, that it is normal. Observe if the baby is spending long periods of the day content and alert (rather than lethargic, overly sleepy, weak, and fussy). Observe any inconsolable crying if it occurs more than 3 times a day, or if you can comfort the baby but it’s unclear why the baby is crying. It’s best to write down the date, time, describe the crying, how long it lasts, and any activities or “symptoms” that accompany the crying, so you and the pediatrician can look for patterns or possible causes.  

Colic

Colic is hard to define, and its cause is still unknown, though we are still guessing and trying to find ways to soothe these babies and provide parents with relief. Advice for treating colic is contradictory, so open yourself up to learning possible relief methods and trying them safely to see if they work or don’t work for you and your baby. Colic is a frustrating topic for parents and caregivers alike, so let’s take a deep breath and calm ourselves, especially if we have a colicky baby or if we’re around someone who does.  Even if our own baby is not colicky, let’s give understanding and support to parents who experience this.

How colic is defined:

  • The infant is less than five months old;
  • The infant has prolonged (3 or more hours consecutively or in a 24-hour period) repeated (at least 3 times in a 7-day period) times of crying/fussiness that is not soothe-able nor preventable and has no other symptoms or obvious cause;
  • The infant has no other symptoms like fever, illness, failure to thrive, etc.  

The pediatrician needs to rule out underlying illnesses or conditions that could be causing the crying (gastroesophageal reflux, allergies, etc). If the crying is due to an underlying problem, there will be other signs other than just crying.

Colic is common in the first 6 weeks of life, typically decreases around 3 months, and is resolved by 4-6 months. It’s still unknown as to what causes colic. The current theory that holds some promise is that it is due to discomfort caused by the infant’s gastrointestinal microbiome and in breastfed infants, probiotic supplementation (Lactobacillus reuteri DSM 17938) might be helpful (in formula-fed babies, the same results were not noted). Another current theory is that colic is due to gut permeability and dead or tyndallized bacteria might help this. Older theories are things like gas/air in the gastrointestinal tract, the mother’s diet/allergies, and too much stimulation.

REMEMBER: The most important part of colic treatment is reassuring and supporting the parents. Like babies, parents are different; some handle crying easier than others, and colicky baby needs large amounts of patience and love. It’s key for the provider to rule out other possible causes or complications causing the crying and help the parents be confident of this, too, then to support the parents in coping with the crying and developing a healthy relationship with each other and their child.

Any intervention done to soothe the crying needs to have no adverse effects; doing something that utilizes the placebo effect is fine. Soothing skills are valuable for all parents to know: swaddling, shushing, sucking, stomach position, swinging (see Dr. Harvey Karp’s site in the resource section to learn these skills—he’s probably on YouTube, too; I especially recommend this for fathers, as they do not have a breast to soothe the baby and needs other ways of interacting with and soothing their small kids).

Things that have been tried but are of questionable effectiveness for colic: maternal dietary changes (no dairy, for example), simethicone, formulas (for formula-fed babies) that break down the allergens in cow’s milk (extensive hydrolysate formulae). These have been tries. Medical studies seem to show that they are not effective, but there are parents for whom they are effective. DON’T USE THESE PRODUCTS  due to their side effects: Dicycloverine or cimetropium bromide.

Trying 2 weeks of oral lactase is recommended in the UK along with prebiotics; this does show some promise. Trying a maternal diet of no dairy for 2 weeks can be tried.  Sears has an elimination diet (see recommended reading).  

Long term, it’s possible that babies with colic have more gastrointestinal pains and disorders as adults, but the immediate emotional effects on the family are even more pronounced—parents are frustrated, depressed, anxious, visit the pediatrician more often, and even child abuse is more likely.

Here’s a Recommended Reading List for colic and baby soothing:

NOTE: Lots of ideas and products to try for colic. However, these are not all categorized as medical recommendations. PLEASE USE YOUR COMMON SENSE; remember, any treatment tried for colic should have no bad effects on the baby.

Ask Dr Sears: “Colic Relief: 10 Tips for Comforting Colicky Babies”

Dr. Harvey Karp The 5 s’s for soothing babies.

Gentle Birth archives

Resources I used to write this paper:

AskDrSears.com. (n.d.). 5 possible hidden medical causes of colic. Ask Dr Sears: A trusted resource for parents. https://www.askdrsears.com/topics/health-concerns/fussy-baby/coping-with-colic/5-possible-hidden-medical-causes-colic/

Daelemans, S., Peeters, L., Hauser, B., & Vandenplas, Y. (2018). Recent advances in understanding and managing infantile colic. F1000Research7, F1000 Faculty Rev-1426. https://doi.org/10.12688/f1000research.14940.1

Davis, E. (2004). Heart & hands: A midwife’s guide to pregnancy and birth (4th ed.). Ten Speed Press.

Gianluca Esposito*, Sachine Yoshida*, Ryuko Ohnishi, Yousuke Tsuneoka, Maria del Carmen Rostagno, Susumu Yokota, Shota Okabe, Kazusaku Kamiya, Mikio Hoshino, Masaki Shimizu, Paola Venuti, Takefumi Kikusui, Tadafumi Kato and Kumi O. Kuroda. “Infant calming responses during maternal carrying in humans and mice”. Current Biology, 2013.doi:10.1016/j.cub.2013.03.041  

trichomonas vaginalis

These are just midwifery study notes, not medical advice 🙂 I am exploring ways to conveniently store information as I study.

“Trich” is a sexually transmitted disease, usually symptomless. It is a parasite. It is curable.

symptoms of infection in women: discharge (thin or foamy; white, greenish, yellowish); pain/discomfort during s’x or peeing; irritation/itching around vag’na.

for diagnosis, a sample of discharge is taken from the cervix/vag’na and looked at microscopically. It can also be noted in urine sample if it is very developed.

treatment is antibiotic pills (metronidazole)–safe in pregnancy, but under question during breastfeeding as it passes through the breastmilk.

concerns of trich infection during pregnancy: low birth weight, prelabor rupture of membranes, preterm delivery.

resources:

Cleveland Clinic about trich

WebMD about treatment

Centers for Disease Control

Midwifery student, reflections on Yr One

It’s not been a year yet, but close, so I’m going to start reflections on this process.

I don’t like being a new midwifery student. It’s constantly being incompetent. It’s uncomfortable relationships sometimes.

However, I am very glad that I persevered during this year. It’s nice to see that I have grown and become so much more competent than I was at the beginning. And I’m in the process of getting into harder skills now.

So the early skills were vital signs—learning to count blood pressure–and realizing that there are several different qualities of sounds to be heard, and which ones to count. . . And hearing the baby’s breathing. And being able to count a fast newborn heartbeat for a full minute.

I’ve learned tricks that help me along. Like when I count the newborn heartbeats, I count to 60, then start over. So I usually have 3 numbers at the end of one minute– 60 + 60 + the third number. 60+60 gets me to 120 easily, then I add on what’s over that. As I watch my second-hand on the clock, I know that if in the first 30 seconds I’ve counted less than 60 or more than 80, then my end count will be outside of the norm. And I adjust accordingly. Is the baby in a deep sleep and that’s why the number is too low? Is the baby crying and upset and that’s why the number is too high? Or is the baby truly sick and is that confirmed by other signs? (We’ve transported several for infections.)

Things like that. Palpation, using a Doppler, sometimes a fetoscope. reading lab results, prenatal education, discomforts of pregnancy, monitoring labor, charting (aaaalllll the charting they do here!), filling out birth certificates, recognizing signs of needing to transport, and the transport process. It’s nice being a in a setting where midwives are an integral part of the medical community.

Skills that are higher level, that I’m working on now are vaginal exams (still struggling with this) and the movements to help the baby out (that they do particularly in this clinic and in supine birth in the hospital) and Active Management steps. The Expanded Newborn Screening is also a challenge.

I took CPR and soon we’ll be getting our NRP (neonatal resuscitation) certification. We’ve learned to insert IV, and I’ve successfully inserted IVs on 2 patients with assistance. I’m also looking forward to starting suturing in a few months. Seen things like hemorrhage and shoulder dystocia.

During this time period, I’ve been the assistant under supervision at 33 births, 11 of those where I was the one catching.

42 postpartum exams as an assistant under supervision, 126 prenatal appointments, 11 initial prenatal appointments.

I will be honest, that I’ve realized how committed I am to homebirth through working at a clinic. This clinic is good in that it fits exactly what women want and need in this cultural context and they are kind and helpful and have a good transport situation. We also regularly pray with our patients if they desire that.

It’s been quite a year.

Coming out of this war in Ukraine has been a double struggle. I’ve found the midwifery and birth work to be a good distraction from that heartbreak. Emotionally, mentally and physically I’ve not been myself, and I’ve been trying to be kind and patient with myself and others. I’ve never been through such a devastating situation and those around me haven’t either, so none of us really know what to expect or what this is like.

It’s been a horrible year, a year I’ve disliked intensely, been intensely homesick and heartbroken. But with God’s help, I’m enduring the suffering, and I am gradually re-emerging out of the darkness. I’m learning to integrate the devastation of my past and present life and the future expectations that I had into this current life. God gradually gives small hopes for the future and I trust him when it is a future that only God sees. I feel like we will not be fully healed until we can return to Ukraine and the war is won in a good way. But God also gave me the promise that he restores my soul. When I feel it is smashed and mutilated beyond help, he is the only one capable of restoring my soul, and he will do it, is doing it.

Brief overview of midwifery in early America through today

(I would like to state that I wrestled for some time with writing this “blog post,” as I am a writer and I have a great interest in midwifery history. This time around with this topic, I became dissatisfied about how much midwifery is usually presented and defined by its opposition to doctors, the medical system, etc. Midwifery has its own glorious, stand-alone history, our own errors and mistakes that we rarely own up to, and I eventually decided to leave out almost entirely the history of medicine, doctor’ persecution, childbirth under early doctors’ (purpureal fever, etc.), and instead just make it a simple, brief actual overview only of midwifery. It is intentionally very brief, and doesn’t go into much detail about the arguments for nurse- or direct-entry midwifery, for example. I was thinking mainly of clients who would only like an overview, not a selective piece of swaying writing highly critical of the medical model nor a deep overload of information about direct-entry midwifery.)

A very brief overview of midwifery in early America through today:

America has a rich history of midwifery care, though much of it is not recorded. The colonists brought midwives among themselves, and later, midwives were also brought among the slaves and immigrants. Knowledge and skills surrounding helping women in childbirth were passed on orally and in hands-on apprenticeship training. Few women were taught to read and write.  Some midwives we know about (because of extant writings) are Bridget Lee Fuller, Anne Hutchison, and Martha Ballard.

In the 1800s, male involvement in medicine and formal training for doctors rose, licensing for doctors became formalized, and along with this, doctors openly promoted the view that childbirth is an inherently dangerous process that requires routine interventions. Midwives, being female, were often illiterate and not trained to write, or they were immigrants and didn’t know English very well, so they could not compete with the growing social and legal power of doctors.  

Wealth and social status are also large factors in childbirth. Wealthy and middle-class women still birthed at home but using a doctor became more accepted. Doctors organized into what became long-standing, powerful, legal organizations like the American Medical Association. Gradually, childbirth moved into hospitals where drug pain medications and many medical interventions could be practiced.

In many countries, midwifery developed as an integrated part of the medical system. However, in the U.S. and Canada, in the first half of the 1900s, midwives were more and more sidelined, put out of practice, or allowed to serve only poor communities. The “granny midwives” of the South are remembered during this time and several well-known biographies are written about their unwavering service to women. Midwives often skillfully and sacrificially served poor communities that were unable to pay for doctors’ services.  Some famous midwives of this time are Mary Breckinridge, Mary Coley, Etta “Granny” Nichols, and Onnie Lee Logan.

Particularly in the mid- to late-1900s, there was a resurgence of middle-class women wanting home birth and midwifery care. Midwives organized as both nurse-midwives and as direct-entry midwives. Each developed their own standards for education and licensing. Some well-known midwives of this era (who also authored popular textbooks and books) are Elizabeth Davis, Ina May Gaskin, Helen Varney, and Anne Frye.

Resources

Connerton, W. C. (2012, May 25). midwifery. Encyclopedia Britannica. https://www.britannica.com/science/midwiferyhttps://www.ohsu.edu/womens-health/brief-history-midwifery-america

Feldhusen, A. E. (2000). The history of midwifery and childbirth in America: A time line. Midwifery Today. Retrieved April 19, 2023, from https://www.midwiferytoday.com/web-article/history-midwifery-childbirth-america-time-line/

Hanna, C. (n.d.). A brief herstory of midwifery and childbirth in America . Happy Mama Healthy Baby Alliance . Retrieved April 19, 2023, from https://motherbabysupport.net/professional-education/history-of-midwifery/

Hill, H. (n.d.). Five black American midwives you should know: The history and impact of black midwives in the U.S. . Hanna Hill Photography. Retrieved April 19, 2023, from https://www.hannahillphotography.com/hanna-hill-photography-blog/5-black-american-midwives

Rooks, J. P. (2012, May 30). The history of midwifery. Our Bodies Ourselves Today. Retrieved April 19, 2023, from https://www.ourbodiesourselves.org/health-info/history-of-midwifery/

The story of the granny midwives, who birthed untold numbers of babies in the rural South. (n.d.). Vimeo. Retrieved April 19, 2023, from https://vimeo.com/211012543.

Varney, H., & Thompson, J. B. (2015). Chapter one: The early voices of midwives. In The midwife said fear not: A history of midwifery in the United States: (pp. 4–19). essay, Springer Publishing Company. (accessed: https://connect.springerpub.com/content/book/978-0-8261-2538-5/part/part01/chapter/ch01)

Update on my studies

I’ve been in school for almost 7 months now.

For academic studies, I’m enrolled in the National College of Midwifery’s program, and I completed several Antepartum classes (Basic Skills, Provision of Care, Risk Screening, Diagnostic Lab Tests and Procedures, Observation & Charting).

I’ve completed several other classes (Family Planning), just waiting for grading.

I’m currently working through History of Midwifery and we’re finishing up Lactation and Perinatal Education.

For my clinical studies, I’ve assisted the midwife at about 80 prenatals, 17 births, 4 newborn exams, almost 20 postpartum exams. I’ve learned venipuncture and soon we start our IV class. Checking vital signs, palpation to determine fetal position, listening to FHTs, evaluating labs, charting–these are all things I regularly practice.

My three philosophical thoughts from this time: 1) I hope the world tires soon of all. the. research. and realizes the limits of what is actually measurable. Reducing these experiences to numbers is a major weakness of the allopathic system.

2) How on earth did the legal system become such a chokehold to good care?!?!

3) I continually remind myself that clinic midwifery has it’s pros and cons. Pros: amount of experience, multiple teachers and input, ability to leave it until the next shift. Cons: lack of the emotional synergy, freedom, and physiology of home birth.

When missiles struck our hearts

My name is Anne Sokol. My last name is Ukrainian; sokol means “falcon” when translated into English. Twenty years ago, I moved to Ukraine, and less than two years later, I married a Ukrainian man, the air to my lungs. We have four children, currently ages 17 to 8.

2022. Rumors of war filled the air, and the evening of January 25, 2022, the US embassy in Kyiv hosted an online meeting for Americans living in Ukraine. “Significant invasion” was mentioned, and we were given instructions on various ways to leave the country, hasten document processing, etc. Emails from the embassy every 2-3 days followed, repeating and updating these warnings and instructions.

We left our apartment January 30. It is now early September, and I’ve never returned to that apartment. We’ve been to Albania, Romania, Moldova, Poland, and in/out of Western Ukraine. Once the war started, three kids and I stayed in Albania while my husband and oldest daughter went to work on the Ukraine/Poland border then into de-occupied areas in Ukraine. We’ve lived in so many places—camps, churches, apartments. We’ve packed and unpacked so many times. Washed clothes in so many different machines. Learned Thank You in various languages. Our wallets bulged with coins of different currencies, and we had to keep track of tiny SIM cards with each new country.

When we left Ukraine ‘just in case,” I had no idea of the emotional terrain ahead of me. We’ve driven through the Carpathian Mountains in the dead of winter, the enormity of the winding Balkan Mountains, the tiny highways of Albania, the lovely roads of Poland, and crossed countless borders. But by far, the emotional terrain of war is the most difficult to traverse. It’s taken me into territories of the heart I never asked to enter and finding my way back across the border is perhaps impossible. My heart must painfully expand to include this land, too, without becoming lost in it.

My husband is a pastor, and my world is shaped by intimacy with God. When the war started, I agreed with God that I would not hide, run away from nor ignore the horrific pain of whatever lay ahead, that we would go through it together. The following are my attempts, in journal form, to express what it was and is like. It includes my intimate thoughts, prayers, events, and, as time passes, my observations about being a refugee and war displaced.

_____________________________

January 25, 2022

The embassy has recommended that Americans leave. So now I’m packing in earnest. Vitaliy left for classes today. I’m taking the van for an oil change today.

January 28

Awakened early with evacuation thoughts. The sadness of leaving our cat, our known home and soft bed. Lord, whatever lies ahead, I thank you. I thank You that You are leading us by the hand in a way suited to us. Fill our hearts with such love for all those we meet. Use us. Use others to love us, too. Help us be sad, be glad, be mad– all in Your way and with and unto You.

22 February

In Albania, waiting. Olympics in China are over so we should know soon if something will happen. Watched Putin on TV, listened to his whole speech… crazy.

Feb 23

Well, we’re feeling better today about returning to Ukraine

25 Feb

Second day of war, full war, in Ukraine. Situation quickly deteriorating.

26 Feb

Oh, such fighting.

28 Feb

Victoria’s birthday. I cried on the guy who arranged a party for her. It’s all so horrible what is happening. And I feel like I can’t cry with Vitaliy because he is also sad. His family is under occupation! I don’t want to burden him with my sadness but to help him bear his. Now I’m crying at a café in Tirana while the kids are at the birthday party.

1 March

Oh God, my life is stuck in this war. Time has stopped for us. We can’t go on. Will it be like this forever?

7 Mar

Day 12 of this terrible war. War. World War. Sanctions. Cyber attacks. And so many words I’d rather not think about.

8 Mar

It’s an all-out holocaust on Ukraine. Very bad in Irpin right now.

9 Mar

Oh God, some days I just feel like throwing up. It’s hell. So here we all are—a pandemic and terrible war during our lifetimes. God, give us maturity, patience to endure hardship and discomfort; love, to shower around us all. Love, for this is your presence.

11 Mar

God, save Ukraine. I can’t take pictures of our “war sigh.” The “war sigh” is a sigh that Vitaliy and I both developed simultaneously—it’s a particular sigh we make when reading and absorbing certain war news. We’re glued to war news.

March 14: Vitaliy is ready to leave with Skyla for helping at the border. Lord, I bless him. Am I angry, always feeling left behind? It’s an old friend [this anger]. Why am I so mad? “Keep me . . . from all evil thoughts which may assault and hurt the soul.” (a prayer from The Divine Hours).

Days are a terrible cycle: I am terrified to fall asleep—that while I sleep, I am not praying. But then I think, my friends in America are waking up and they are praying while I sleep. Then I wake up, horrified, roll over and grab my phone to check the news. Is Ukraine still there? Praying.

I finished my latest diary. When I started it on November 17, 2021, I had no idea it would be a “war diary.” Flipping through those days of November, December, January– such a banal, sweet life: home school, sick kids, Hercule Poirot reruns… Such different life it was. It becomes a dream, a life hit by a missile and exploded into a million pieces. Gone.

We were walking to church today and Victoria suddenly said, “I’m tired of this.” And we all agreed. We are tired. We are tired of never having a home, never having a home the way we like it. Never able to relax. And there is no *homecoming* in sight. What to do with this tiredness?

This church in Albania is so full of love for us. They have activities for the kids, which I never anticipated how important that would be, because what else are displaced, homeschooled kids going to do? And the people here have fresh memories of the Serbia/Kosovo war, so they are full of compassion.

One Sunday not long ago, I picked up the church information letter, and it was talking about how they needed children’s workers. So I was reading the letter, imagining myself volunteering with the children during church, ready to sign up. Then the final line said that those interested in serving should contact so-and-so for an information packet.

I’m not sure I can explain in words this experience. I read the words “information packet” and suddenly I wanted to heave into major crying. I just wanted to wail, hard and deep. An overwhelmed cry of how it’s all too much and adding an Information Packet to it all just tipped the scales of emotional control.

It was one of the most bizarre experiences of my life. I, Anne, who love information packets! Who have dealt with more paperwork and documents than the average bear can even imagine. Here I am, reduced to an incapacitated mess by the idea of a volunteer information packet.

Volunteering for the children’s ministry is probably not what I should do at this point.

I haven’t had the heart to post any family photos on FaceBook while this horrible genocide is going on in our beloved country. I have a deep sense that I must respect the horror of what people in Ukraine are experiencing. I feel it with them, and I have no desire to post my usual photos of what the kids do during the day while, in real time, people are being tortured, raped, and destroyed in the most unthinkable ways.

Normal life hurts. It hurts to exist in normalcy because, while I drink a coffee or do a math lesson, people are living in this hell.  

I’ve decided to let people here love me in an uncomplicated way.  I desperately need their love and comfort. I’ve noticed this trend of criticizing things people say when trying to comfort those in tragedy. Like those lists of phrases one should and shouldn’t say to those grieving.

It’s helpful to some extent, but poor people! I’ve never been in a war before; I have no idea what people should or shouldn’t say to me. So how will they know what is correct to say to me? I’m committing myself to accept people’s love to me no matter what words came out of their mouths. I’ve been surrounded by compassionate people, and I’m not going to close my heart off by criticizing their love. I need their love, I need their compassion. It’s how God made us in His image, to be comforters. And to need comfort.

Poor people. They also hear and read about this war and are slightly traumatized, they are also inconvenienced by the gas prices and other issues, and this war has been politicized by their own media and government, so who knows what they are hearing and believing.

Last Sunday, a lady at church asked me how I was doing, and then she looked embarrassed for asking me that. But she was trying so hard to reach out to me and be friendly! She wanted to show love to me and welcome me. So I smiled and said I was fine. Another lady acknowledged that my life is just about survival right now and survival is exhausting, and I was surprised by the truth of her comment. Even though I’m “safe” and thousands of kilometers away, she is right.

In a rare outing with kids, we were sitting in a group, and one lady asked the perfect question that opened the way for me to share my feelings about this war. I can’t remember what she asked, but it was spontaneous and kind, expressing her own horror about it. They didn’t ignore my pain or feel uncomfortable about it.

There is one time I struggled with this principle. There was one moment when a person publicly prayed a general sentence for Ukraine, then paused and prayed the same general sentence for Russia. And I felt like I had physically been struck–praying identical prayers for the abuser and the abused!

But if I think compassionately about this, it was just a person who had too much distance from the situation to feel the nuances. She wanted to show love, and she was doing it as she knew how. [And later that person cried buckets when we moved on from that place.]

Doing a small thing alters lives, March, Albania still.

I’ve never met G—, I’d only written him about homeschooling in Ukraine. He’s from Canada. Canada has been quick about starting their refugee program for Ukrainians, and G wrote me saying they had some Canadian families organized, ready to sponsor refugees. Here I am alone in Albania. But I know Ukrainian refugees in Romania, Poland, Germany, France, Hungary, Spain, Czech. And Ukrainians are excellent networkers.

Just feeling obligated, I took a few minutes to write a brief message in Ukrainian about this Christian man G, who was willing to help Ukrainians who wanted to move to Canada. I put his contact email in there and said to mention that Anne Sokol told you to write. I posted this message in 3 social media groups (I was pretty sure that by the end of the day, it would be all over the place).

Jump forward to July. I must confess that when I sent that message out in March, I hardly thought about it. But G thinks I know everyone in Ukraine from all the people writing him that Anne Sokol told them to write. At least 10 refugee families have moved already, and more are in the process. I had no idea the scope of G’s plans, and I want to cry about how amazing they are. These thoughtful people have organized themselves and their whole community to integrate Ukrainian families into their space. They even give them option of flying the family back to Ukraine in six months, if they so decide, which is what every refugee needs to hear who is making these life-altering decisions unwillingly.

M and B (a married couple from our church in Ukraine) were the first to immigrate to Canada. Months later, thanks to G and all the Canadians helping them, she wrote: “Exactly three months ago we flew to Canada. Five months ago, we lost everything that was dear to us in life, we didn’t know how to live further, what to dream about or strive for. Now we have new dreams and hope, and we again want to continue living. Thank God for G…”

April, still in Tirana, Albania, still without my husband

We moved away from Ukraine to be safe. I didn’t expect feeling myself in danger. I feel pursued and in danger. I am very glad we live in the second-floor apartment of this house, with a family downstairs, and a high fence around us. It helps me a lot with feelings of safety. Even the glass shards along the top of the fence comfort me. I am alone looking after our kids, and I feel like, even here, because of propaganda, people are coming to find and kill my half-Ukrainian children. How will this war go? What will the world believe? What will the European leaders decide long-term? Will everyone believe the terrible Russian propaganda? I don’t post any photos or place-identifying information. Call it paranoia.

The longer this war goes on and the more bizarre and unrealistic the propaganda, the more I feel myself in danger.  Plus, it becomes obvious that Putin wants to wipe all things Ukrainian out of existence, so all the more I feel that my children are in danger.

April 7:

God, my heart! They are extinguishing our people! Our culture!

I did not anticipate the emotions of this experience at all. Also, I didn’t anticipate the hateful politics. This war is Russia’s delusions of grandeur and its ideology about Ukraine.  But each country takes it and makes it about their own politics–to them, their own politics is the cause/prevention/meaning of the war. I no longer feel safe because a lot of people who’ve never been to, much less lived in, and have hardly even heard about Ukraine, are suddenly more knowledgeable about who we are than we ourselves are. This actually causes me much pain, and I never expected this. At all.

May 2022, Romania

Tonight, as I was getting ready for bed, I realized that I was looking forward to waking up. For many weeks when the war started, I dreaded waking up; it was painful to be conscious, to be awake, aware of what was happening. So I tried to stay asleep as long as possible.

I assumed that “recovering” from these war emotions would be like going down a mountain– I would logically move downwards and out of all these feelings.

It is not logical nor downwards. It is waking up every day to the emotional carousel ride. Round and round on the same emotions, sometimes going up a little, or down a little. Round and round.

I’d “recover” from an emotion, think, phew, glad I’m done with that horrible experience. Then bam, there it was again.

I’m glad we have photos of us smiling. At some point, I’ve stopped smiling so much. It’s not worth the effort right now. Not many people ask me how I’m doing, but when someone does, sometimes I tell them I’m OK, sometimes I tell them I’m terrible. Both are true. Because it is the most terrible thing that has ever happened to me, but I’m still OK.

It’s still February 24, 2022, in so many ways. The date that destroyed the lives we all had. We remain frozen but in motion. I’m trying to somehow integrate the devastation and somehow build a life out of this experience. It’s an untimely rebirth of sorts, a rebirth from destruction, not from life.

Years ago, in Kyiv I got acquainted with a lady who was a religious refugee because of persecution. She said to me one sentence I’ve never forgotten. “I don’t live a life here. I’m just watching other people live their lives.”

I’m in these places, and when I can look up from the pain, I am watching others live their lives while mine is frozen, back in Ukraine, in the war. I’m waiting for the end of the war, forced to figure out an “in-between life” somehow, somewhere.

Our stresses used to be so simple. Education of our children. Money questions. Ministry issues.

We’re doing pretty well. But in my angry weeks, early on, when Vitaliy was gone, and I was periodically hemorrhaging my repressed anger (and Vitaliy is my safe person to do that with, poor man), we had some tense conversations, along with all those lovely internet problems that complicate heartfelt, long-distance communication.

It was nice to be reunited, to hold hands and eat ice cream and drink coffee together, to chat about the animals in the fields. To soften the hard things.  So many couples are forced to make life-altering decisions that came upon them in this unnatural, destructive, grief-wailing situation. Working through decisions they never wanted to make.

June 2022, Poland

It’s time to step over some line, from focusing on the horrible present in Ukraine, to focusing on the future that is before our family.

I’ve been trying to get rid of these feelings of sadness and anti-anticipation about our future. I’ve been having a lot of anxiety that is unfamiliar to my own life experience. I’m feeling a lot of stress about moving between my “sad life” here and my “happy life” that I so desperately want to have in our next permanent location. All my imaginings of moving are colored by feeling sad all the time. But I don’t want to feel sad there. I wanted to feel happy and excited.

How strange! I usually love “adventure,” but during this war, I realized that “adventure” takes on a horrible new meaning. I remember sitting in Romania and thinking, “I don’t like this adventure, not at all.”

In a way it’s comfortable to stay here, in a life in contact with other Ukrainians who are displaced, who are living in cramped and uncomfortable places, trying to fashion a life they never wanted to live, carrying around this invisible pain and trauma. We can sigh about the latest bomb destruction together. Moving on is scary.

But like other refugees who’ve gone to Canada, England, the US, etc., we’re taking the risk of a new place, of a life not really touched by this sadness. I talked to God about this, about how I can’t feel very much all the ways He’s blessed and protected us during this time. I can just feel and anticipate pain and sadness.

So I started to think specifically about things He’s given us … especially all the friends who can see a bright future for us when I cannot feel it.

July 2022, Poland

I’ve never read about a condition called “Refugee Brain”, but I’ve now had it, and so many others have, too. The decisions we make must look hasty or crazy to outsiders. But with all the unseen factors that are constantly shuffling around in our heads, a particular decision makes perfect sense to us. It does not make sense at all to someone living a stable life, sincerely wanting to help in the best way. I’m amazed by those who remain able to help refugees in the long term without becoming cynical about this.

I’ve been walking around feeling like someone poured Jell-o into my head, then used their fingers to mash it up.  But this morning I had a moment of feeling like my former brain was back in my head, the brain that could make decisions, handle lots of details, and go through complex processes like international flights. It was there for a brief moment. I was standing at the bathroom sink, feeling it in there, so strong and capable.  

Imagine, all these refugees with “Refugee Brain,” having to make life-altering decisions and do more documents and paperwork than they ever have in their entire lives.

I’m glad now that I’ve photographed some memories of this strange, sad time in our lives. We smile, do happy things, while our hearts are bombed into a million pieces. The first 3-4 months of this war, I wouldn’t let myself cry; I was alone with the kids, holding it together.

Now I can’t hold it back. I just leak tears all day. The TP roll is my undignified friend. The losses stemming from this event don’t get easier, they get harder and sharper. I’m sure that at some point this will turn around, but it’s not yet. “Yet I am confident I will see the Lord’s goodness while I am here in the land of the living. Wait patiently for the Lord. Be brave and courageous. Yes, wait patiently for the Lord.” Psalm 27:13-14

I want to record again a bright gift God gave us–Skyla’s new dog. He’s a “refugee” puppy from Ukraine, so we love him all the more. The grief of losing all her relationships she’s had since birth is somehow soothed by this new doggie she can befriend and attach to.

It was hard to lose our cat due to this war, and I was surprised by the sadness I felt about that later. The sad memories are made smaller by new memories, and the sharpness of the loss is less. But there is something terrible about giving up a creature you’ve cared for, and in such violent circumstances. Una keeps remembering the cat and praying for her.

I still feel like big pouches of tears are stored behind my eyeballs. Vitaliy asks if I’m still leaking. But I also experience more moments of feeling like the person I used to be, so the Anne that loved her life and had energy and interest for many things must still be down in here somewhere.

August, 2022—we’ve moved to a permanent location

For months, there is this hope or expectation that suddenly I will wake up or suddenly the war will stop, and in a snap, the sadness will be gone; life will instantly return to the emotional flow it once was.

I was imagining that this will be like a light switch: On. Off. I’ve been waiting and waiting for that click Off. For my emotional landscape to go back to what it used to be.

It slowly dawns on me that the sadness will never go away entirely. It will never turn Off. I will have to live with this Sadness. It must become a part of me; I have to integrate it into my future life: That I will choke up unexpectedly when holding new babies or thinking about Christmas. That swallowing back tears around people untouched by this tragedy will be a new part of life.

I recently read about an extreme case of this in a book about the Hmong refugees who ended up in America. A quote from an American psychologist describing his Hmong patient: “It turned out he was an agoraphobic. He was afraid to leave his house because he thought if he walked more than a couple of blocks he’d get lost and never find his way home again. What a metaphor! He’d seen his entire immediate family die in Laos, he’d seen his country collapse, and he never WAS going to find his way home again. All I could do was prescribe antidepressants.” (The Spirit Catches You and You Fall Down by Anne Fadiman, p. 204)

Another way I often feel these days is … numb. Not happy, not sad, not excited, not dreading. There is something soothing about this particular stage after all that’s been before. But it would be nice to feel some kind of pleasant emotions.

Just before we flew here, I remember having about 30 seconds every morning of feeling anticipation and excitement. That has left me. When I was first here, I had a few first meetings that involved certain urges to cry.

I don’t like being emotionally flat. I worry that I’m depressing to be around. But I don’t think I’m technically depressed. I’m just riding all this out. Who can control it? I’m controlling what I CAN control– like reminding myself of loving God, waiting to feel emotions towards Him again. Reading the Bible. Praying. Doing the work I ought and want to do every day. Also resting.

My worst fear is that I will be stuck in this flatness-bordering-on-sadness forever. But I think that’s a ridiculous idea, as humans are so changeful.

I was thinking recently about the one-year anniversary of the US military leaving Afghanistan and comparing it to Ukraine. The people of Afghanistan are in a seeming place of such setbacks a year after their president suddenly fled the country.

I remember, when Russia invaded Ukraine, the US immediately offered a refuge/government-in-exile option to President Zelensky. And he refused with his famous words: “I need ammo, not a ride.”

And, in the providence of God, that made all the difference. Russia immediately spread rumors that Zelensky had fled Ukraine, but I remember watching, with Vitaliy, Zelensky and all the major leaders of Ukraine–on live video–recording themselves and reassuring the people of Ukraine that they were right there, in the capitol city.

And, in the providence of God, it’s made all the difference. This leader chose to stay and suffer with his people. He has chosen to live with the overwhelming stress and trauma of leading Ukraine through a disgusting, relentless, brutal war. He’s not let the defamation of character stop him. He has, with great dignity and with relentlessly reminding the free world of the price of freedom, asked, asked, and asked for weapons to fight with. He’s not given up after incredible physical, psychological, and moral blows have struck us over and over.

There is something emotionally healthy about his staying and fighting—the loyalty, the striving for justice.

I’m thankful today for God’s providence in leaders for Ukraine, who are willing to risk their lives, health, and futures in the face of such incredible darkness. And we all keep praying, which feels like grasping God’s muscular arm in the darkness, for the future still hangs in the balance.

About the end, whatever that end will be, I also feel nervous. Once it ends, especially if Ukraine wins, we’ll be free to feel and acknowledge the horror of what we experienced, and I think all the grief and shock will be experienced a second time, in even more awfulness because it will be opened up for all to see and know. And the unhappiness of destroyed lives still having to be lived.

But what if Ukraine is forced into a compromising end? To somehow make peace with the evil? That type of end will darken these continually-beaten-down people, and we’ll face a new level of cynicism and hardening. I don’t like to think it, but maybe fighting (as it now is) will be better than the end. Now at least, we’re fighting the evil.

People ask me what they can do about the war and to help refugees. I don’t hurry to answer this question.

Years back I read a book, Visions for Vocation by Steve Garber. I remember one pivotal thought from that book that really affected me. The author recounts stories of young people moving to Washington, DC, with lots of passion and visions of changing such-and-such an issue. Then they get disillusioned realizing they can’t “fix it.”

And the author makes the point that we have to be OK with doing *something* good, with doing something in the good direction. And that thought has stuck with me for many years because the savior complex wants to save everyone and fix everything. To make it all completely right.

But only Jesus will do that. So can I be fulfilled and satisfied with doing the good works He made me to do, living in the tension of not being able to fix it all? It’s an important moment. Because if I don’t accept the grace of my limitation, then I tend to give up. All or nothing? then nothing. Like, if I can’t give the entire million dollars, why send one? If I can’t stop the war, why do anything at all?

Singlehandedly, no one can’t stop the war. But each can use his ‘hand’ to do *something,* and it’s important that we use our agency to do that something. I’m thankful for those who ask, What can I do?

I am so touched by many things these days that would never have touched me if I had not been forced to cross into the emotional territory of war. Today’s tears were brought on by the beautiful first line of Rachael Bunger’s poem “I Am.” (She is, incidentally, also a half-Ukrainian teenager, like my own teenagers.)

“I am a star, small but crucial in this night.”

Start of my 6th week

Last night I worked on night shift, and for the first time ever, I was taught how to check the fundus after birth, and I checked it myself once, too. I was thrilled that it’s actually there and palpable. I’ve always thought it’s crazy to try and feel for an organ inside the abdomen, and I didn’t believe I’d actually be able to feel anything. But I did!

I also learned in my reading that the #1 way to prevent tears during birth is a slow pushing stage. (And it’s actually better when the head emerges between contractions.) Last night I saw a physiologically “slow” (ie, absolutely normal) second stage. And no tearing 🙂 Which also helps there to be decreased blood loss.

My clinical experience

I’ve been in school for 5 weeks–today is Saturday; it’s the completion of the 5th week. Week one was Orientation Week.

I’ve worked 5 shifts in the birth room (one shift I worked in August, because I arrived early). I’ve observed 5 births here. While working birth room shifts, I also observe immediate postpartum care, the newborn exams, 24-hour postpartum observation, newborn screening and discharge. I also observe return mother-baby checks (each client is under the clinic care through 6 weeks postpartum).

I’ve worked 4 days in the regular prenatal care room, taking vitals and observing a midwife doing prenatal visits. One of those days was a day of initial prenatals (the mother’s first visit to the clinic during her current pregnancy).

I’ve stared learning to measure fundal height, palpation of the fetus and finding and timing heart tones using a doppler.