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Inglês

Mild, maculopapular skin lesions may develop in acute infection within hours after exposure to cercariae. Significant dermatitis is rare with the major human schistosomal pathogens, probably because the invading and developing cercariae are minimally immunogenic. However, abortive human infection with schistosomal species that rely on other primary hosts may cause marked dermatitis or swimmer's itch. This self-limited process may recur more intensely with subsequent exposures to the same species.

Indonésio

Gejala biasanya hilang dalam beberapa minggu, tetapi sindrom ini bisa berakibat fatal. Pengobatan dini dengan obat-obat cidal dapat memperparah sindrom ini dan memerlukan terapi glukokortikoid bersamaan. Turis dan pelancong paling mungkin hadir di UGD di Amerika Serikat dengan sindrom ini. Riwayat kontak pasien dengan air tawar, seperti melalui berenang, berperahu, arung jeram, atau ski air, harus diperoleh.

Última atualização: 2018-10-25
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Inglês

1 00:00:07,280 --> 00:00:12,400 Painting of a Gothic castle, artist unknown, circa 1920s. 2 00:00:12,760 --> 00:00:17,959 Oil on canvas, 20-by-28. Miss Franklin, where did you say you got this? 3 00:00:18,120 --> 00:00:23,638 I inherited it a few months ago. But it's been in my family for generations. 4 00:00:24,120 --> 00:00:27,157 The composition is so unusual. 5 00:00:27,320 --> 00:00:30,073 The artist used pure colour straight from the tube and then varnished 6 00:00:30,240 --> 00:00:33,994 - each layer over and... - I'm sorry for interrupting. 7 00:00:34,200 --> 00:00:35,997 But do I really need to be here? 8 00:00:36,160 --> 00:00:40,517 No, of course not. It's just that most people prefer to be at an appraisal, 9 00:00:40,680 --> 00:00:42,591 especially when they plan on selling the piece. 10 00:00:42,760 --> 00:00:46,036 - It's just that I'm kind of in a hurry. - Say no more. 11 00:00:46,200 --> 00:00:49,272 Just sign at the bottom, and you are free to go. 12 00:00:49,440 --> 00:00:53,353 Thank you. So how long do you think it'll take to sell it? 13 00:00:53,560 --> 00:00:56,632 Well, I'll need to see ownership records before I can do anything. 14 00:00:56,800 --> 00:01:00,076 I'll send you everything I have. So is that all, then? 15 00:01:00,240 --> 00:01:02,071 No, since you definitely wanna sell the piece, 16 00:01:02,240 --> 00:01:05,152 I'll need to confirm its authenticity, its physical condition. 17 00:01:05,320 --> 00:01:07,151 So if you'll just sign at the bottom, 18 00:01:07,360 --> 00:01:09,157 that will let us go ahead and x-ray the piece. 19 00:01:09,760 --> 00:01:11,751 Done. 20 00:01:12,240 --> 00:01:14,754 - Anything else? - Um... 21 00:01:15,320 --> 00:01:18,949 Well, yes, Miss Franklin. I would really like the time to research this. 22 00:01:19,160 --> 00:01:21,037 That way I can get you the best price. 23 00:01:21,200 --> 00:01:26,194 Look, I appreciate your professionalism. I really do. 24 00:01:26,360 --> 00:01:28,920 But I'm not interested in getting the best price. 25 00:01:29,080 --> 00:01:33,835 I just want you to sell that painting as soon as you can, all right? 26 00:01:34,840 --> 00:01:37,149 - Good night, Miss Halliwell. - Good night. 27 00:01:47,920 --> 00:01:50,832 Piper, it was an accident. It's not like I borrowed Prue's car 28 00:01:51,040 --> 00:01:53,679 - so I could drive it into a pole. - How bad's the damage? 29 00:01:53,840 --> 00:01:56,638 Not bad, but maybe expensive, which is why I need a favour. 30 00:01:56,800 --> 00:01:59,439 If you're calling to borrow money, I don't have any. 31 00:02:00,000 --> 00:02:04,152 No, it's not about money. It's just... I don't want you to tell Prue. 32 00:02:04,320 --> 00:02:07,517 She's been so supportive, and I don't wanna lose her trust again. 33 00:02:07,680 --> 00:02:11,116 - You mean you haven't told her? - Well, not yet, but I have a plan. 34 00:02:11,280 --> 00:02:12,508 Phoebe, you have to tell her. 35 00:02:12,680 --> 00:02:14,955 It's her car, and you don't have the money to fix it. 36 00:02:15,120 --> 00:02:17,759 But I will have the money to fix it. I'm at this company called 37 00:02:17,920 --> 00:02:20,912 Web San Francisco. It's an interactive network on the Internet. 38 00:02:21,120 --> 00:02:22,678 And I faxed them my résumé this morning, 39 00:02:22,840 --> 00:02:24,398 and they wanna meet with me tonight. 40 00:02:24,560 --> 00:02:26,869 I've gotta go, but I don't wanna be in the middle of this. 41 00:02:27,040 --> 00:02:30,077 - Just tell her, okay? - If I don't get the job, I will tell her. 42 00:02:34,120 --> 00:02:35,792 [SIGHS] 43 00:02:47,720 --> 00:02:51,998 Hello, I'm Phoebe Halliwell. I have an appointment. 44 00:02:55,120 --> 00:02:56,439 Thanks. 45 00:02:57,080 --> 00:03:00,231 All these people, they're here for the interview too, aren't they? 46 00:03:00,440 --> 00:03:03,034 Well, you won't have any trouble with this if you figured that out. 47 00:03:03,200 --> 00:03:06,158 It's an aptitude test. You can finish it at home. 48 00:03:06,320 --> 00:03:08,072 Great. Great. 49 00:03:12,560 --> 00:03:15,358 APPLICANT 1: You won a fellowship from the National Science Foundation? 50 00:03:15,520 --> 00:03:17,636 When I was at Harvard, yeah. How'd you know? 51 00:03:17,840 --> 00:03:20,912 I saw it on your résumé. I was cum laude also. 52 00:03:21,080 --> 00:03:22,832 APPLICANT 1: Except I was a Ford Foundation scholar. 53 00:03:23,080 --> 00:03:25,389 So then you must have gone to Stanford? 54 00:03:25,640 --> 00:03:27,392 Stanford? I went to Stanford. 55 00:03:29,080 --> 00:03:30,752 APPLICANT 2: Intimidating, isn't it? 56 00:03:31,120 --> 00:03:33,350 The Good Will Huntings or this aptitude test? 57 00:03:33,560 --> 00:03:37,189 Oh, who cares about linear algebra or differential? And that test is a snap. 58 00:03:37,360 --> 00:03:39,191 I mean, in this day and age, who can't write 59 00:03:39,360 --> 00:03:41,555 in HTML and numeric languages, right? 60 00:03:41,720 --> 00:03:42,709 [CHUCKLING] 61 00:03:42,880 --> 00:03:43,869 Right. 62 00:03:45,840 --> 00:03:49,833 Yeah, that's... That's for you. 63 00:04:04,800 --> 00:04:06,631 What? 64 00:04:13,680 --> 00:04:15,352 Oh... 65 00:05:41,720 --> 00:05:45,156 At first I just thought that it was a reflection off of something in the room. 66 00:05:45,400 --> 00:05:48,119 But then when I moved closer, I saw a man 67 00:05:48,280 --> 00:05:50,589 inside the painting, in the castle. 68 00:05:50,760 --> 00:05:54,958 Right, but the moment I saw him, he backed away from the window. 69 00:05:55,160 --> 00:05:58,436 And then there was this strange glow that went past the window again. 70 00:05:58,600 --> 00:06:00,591 It was just so... 71 00:06:02,320 --> 00:06:03,878 - Piper? - What? 72 00:06:04,960 --> 00:06:08,509 - We were talking? - I know, about a man in a painting. 73 00:06:08,720 --> 00:06:12,110 Listen to this one. "Hallway near club entrance too narrow." 74 00:06:12,280 --> 00:06:14,430 I thought that we had discussed your code violations. 75 00:06:14,600 --> 00:06:15,953 Well, I keep finding more. 76 00:06:16,120 --> 00:06:18,509 The plumbing, the electrical, the heating. 77 00:06:18,680 --> 00:06:20,830 - It... None of it is up to code. - Stop. 78 00:06:21,880 --> 00:06:24,440 - You're obsessing. - Well, it runs in the family. 79 00:06:25,040 --> 00:06:26,678 I don't obsess. 80 00:06:27,480 --> 00:06:32,349 I think intensely. Anyway, I can't really help it. 81 00:06:32,560 --> 00:06:35,552 I mean, we've seen so many bizarre things, why not a man in a painting? 82 00:06:35,720 --> 00:06:37,472 At least he's safe from building inspectors. 83 00:06:37,720 --> 00:06:40,109 I can't imagine that castle's up to code. 84 00:06:40,280 --> 00:06:43,556 I'm sorry, but I couldn't find anything in the Book of Shadows about people 85 00:06:43,720 --> 00:06:46,951 who may be trapped inside paintings. I looked everywhere. 86 00:06:47,440 --> 00:06:51,877 Hey, you were asleep by the time I got home. How did your interview go? 87 00:06:54,160 --> 00:06:55,752 It went fine. 88 00:06:56,000 --> 00:07:00,073 Actually, it's still going. I have to finish this take-home aptitude test, 89 00:07:00,240 --> 00:07:02,674 which I actually think I will start right now. 90 00:07:02,840 --> 00:07:05,149 So I will see you guys later. 91 00:07:05,360 --> 00:07:06,713 - Phoebe? PHOEBE: What? 92 00:07:06,880 --> 00:07:09,553 Aren't you forgetting something? My car keys? 93 00:07:13,400 --> 00:07:15,868 They'd be with your car... 94 00:07:16,880 --> 00:07:20,395 ...which is at the body shop, having an estimate. 95 00:07:20,960 --> 00:07:25,909 - An estimate? - Yeah, I bumped... 96 00:07:26,320 --> 00:07:30,598 No, actually I backed your car into a pole last night. 97 00:07:31,440 --> 00:07:33,158 A pole? 98 00:07:34,320 --> 00:07:35,548 You hit a pole? 99 00:07:35,720 --> 00:07:38,314 Yeah, you don't even have to say it. I know what you're thinking. 100 00:07:38,480 --> 00:07:41,836 How could I be so irresponsible? How could I be so stupid? 101 00:07:42,240 --> 00:07:46,518 Okay, irresponsible, yes. Stupid, no way. Where is that coming from? 102 00:07:46,680 --> 00:07:48,830 It's coming from the fact that I'm the youngest sister, 103 00:07:49,000 --> 00:07:51,958 the one who always makes mistakes, the one who always causes problems. 104 00:07:52,120 --> 00:07:54,793 I mean, if anybody were gonna back your car into a pole 105 00:07:54,960 --> 00:07:57,030 and not tell you right away, it'd be me, right? 106 00:07:57,880 --> 00:08:00,758 - I think I'll just be going now. - See? Even the middle sister, 107 00:08:00,920 --> 00:08:03,912 the one that's supposed to stay neutral when it comes to family problems, 108 00:08:04,080 --> 00:08:06,799 - checks out on this one. - Yes, you're right. You're on your own. 109 00:08:06,960 --> 00:08:09,428 Well, leave me out of it too. I don't wanna argue with you. 110 00:08:09,600 --> 00:08:12,956 - I just wanna find a cab. - Well, whatever it costs, 111 00:08:13,120 --> 00:08:15,680 I will pay for the damages. And whatever the cab costs, 112 00:08:15,840 --> 00:08:17,592 I will pay for that too. 113 00:08:20,760 --> 00:08:23,877 - What just happened here? - I don't know anything about anything. 114 00:08:24,080 --> 00:08:26,150 - I'm gonna go see Dan. - Piper! 115 00:08:26,320 --> 00:08:29,835 Just forget about the car. What about the man in the painting? 116 00:08:30,200 --> 00:08:34,352 Well, unless he's real and screaming for help, forget about him. 117 00:08:34,520 --> 00:08:37,353 We shouldn't go looking for trouble. We have enough around here. 118 00:08:37,960 --> 00:08:40,110 I'm going next door. 119 00:08:48,680 --> 00:08:50,671 - Dan. - Good morning. 120 00:08:50,880 --> 00:08:53,792 - I'm sorry to bother you. - No, you're not bothering me, unless 121 00:08:54,080 --> 00:08:57,550 - you refuse to hand over my paper. - Oh, all yours. 122 00:08:57,720 --> 00:09:01,952 - Thanks. You wanna come in? - No, no, really, 123 00:09:02,160 --> 00:09:05,232 I just stopped by to ask a quick favour. My club received a visit 124 00:09:05,400 --> 00:09:07,755 - from the DBI last night... - And you got code violations. 125 00:09:07,960 --> 00:09:10,679 I have the War and Peace of code violations. 126 00:09:10,880 --> 00:09:14,475 And you were thinking what? Neighbour Dan, he's in construction, 127 00:09:14,880 --> 00:09:18,031 - maybe he could help, huh? - Of course I'd pay you something. 128 00:09:18,640 --> 00:09:21,916 JENNY: Uncle Dan, I'm late. Hey, Piper. - Hi, Jenny. 129 00:09:22,080 --> 00:09:26,517 See you later, Uncle Dan. And don't forget your promise. 130 00:09:27,920 --> 00:09:32,198 Okay, then, I'll tell you what I can do. I'll check out the code violations, 131 00:09:32,360 --> 00:09:35,272 see how serious they really are if you will help me with the promise 132 00:09:35,440 --> 00:09:38,159 - I made Jenny. - Deal. Wait, what's the promise? 133 00:09:38,320 --> 00:09:42,199 She needs help with a paper. It's... It's for bio class. You know, something 134 00:09:42,400 --> 00:09:46,473 - with the human reproductive system. - Oh, you mean sex. 135 00:09:47,440 --> 00:09:50,477 It's just way too awkward for me to talk to my niece about. 136 00:09:50,680 --> 00:09:54,309 Yeah. Sure, not to worry, I have plenty of experience. 137 00:09:54,880 --> 00:10:00,398 - Really? With sex? - No, I mean, talking about it. 138 00:10:02,880 --> 00:10:04,279 Yeah. 139 00:10:07,920 --> 00:10:09,876 So was there a problem with any 140 00:10:10,040 --> 00:10:11,792 of the ownership records that I sent over? 141 00:10:11,960 --> 00:10:13,632 No, everything's in order. 142 00:10:13,960 --> 00:10:15,916 Then I'm not sure why you wanted to meet with me. 143 00:10:16,080 --> 00:10:19,550 Look, Miss Franklin, I know that you don't really wanna be here, 144 00:10:19,720 --> 00:10:25,078 so I'll just be perfectly honest. There is something strange about that painting. 145 00:10:26,160 --> 00:10:28,549 - Have you seen him? - Him? 146 00:10:29,200 --> 00:10:32,590 - That's how it all starts, you know. - What do you mean? 147 00:10:32,760 --> 00:10:36,070 At first, you see him... 148 00:10:37,400 --> 00:10:38,799 ...the man inside the painting. 149 00:10:39,760 --> 00:10:45,039 At least you think you see him, but he just... He disappears so fast. 150 00:10:46,720 --> 00:10:49,951 And you start to think about it, but it doesn't make any sense. I mean, 151 00:10:51,200 --> 00:10:56,035 how could a man be inside a painting? And then you see him again. 152 00:10:56,560 --> 00:10:58,596 This time longer. 153 00:11:01,600 --> 00:11:03,352 And now you're sure. 154 00:11:03,520 --> 00:11:06,318 So you think that the painting is haunted by a ghost? 155 00:11:07,000 --> 00:11:11,312 Oh, no, no, I think he's definitely alive. 156 00:11:12,120 --> 00:11:14,588 I think he's trapped inside. 157 00:11:16,120 --> 00:11:19,590 - Do you know who he is? - No, I have no idea. 158 00:11:20,600 --> 00:11:22,272 Nobody does. 159 00:11:23,960 --> 00:11:27,748 Look, all I know is that if I don't get rid of that painting, 160 00:11:28,000 --> 00:11:30,878 I'm gonna end up just like everybody else in my family who ever owned it. 161 00:11:31,080 --> 00:11:33,071 - I'm gonna be completely insane. - Miss Franklin... 162 00:11:33,240 --> 00:11:35,196 No, you've only seen the beginning, Miss Halliwell. 163 00:11:35,400 --> 00:11:39,712 Just trust me when I tell you it's only gonna get worse. 164 00:11:48,880 --> 00:11:54,318 Spirits send the words from all... 165 00:11:54,480 --> 00:11:55,469 [KNOCKING] 166 00:11:55,640 --> 00:11:57,278 PIPER: It's me. Can I come in? 167 00:11:57,440 --> 00:11:59,795 Piper, I really just wanna be alone right now. 168 00:11:59,960 --> 00:12:02,633 I won't stay long, promise. 169 00:12:03,560 --> 00:12:05,630 All right, just give me a sec. 170 00:12:10,120 --> 00:12:11,394 Okay, you can come in now. 171 00:12:15,880 --> 00:12:19,998 I just wanted to tell you the body shop called. 172 00:12:20,440 --> 00:12:22,351 Yeah, I know, I heard the message, 1,200 bucks. 173 00:12:22,520 --> 00:12:25,876 - Did you tell Prue? - I didn't have to. She already knew. 174 00:12:26,040 --> 00:12:27,473 She called the body shop herself. 175 00:12:27,640 --> 00:12:29,551 That's why I have got to get this job, Piper. 176 00:12:29,760 --> 00:12:31,796 It's the only way that I could pay for the damages. 177 00:12:32,000 --> 00:12:33,558 The only way I can make things right. 178 00:12:33,760 --> 00:12:35,637 All the more reason you just should've told her. 179 00:12:35,840 --> 00:12:38,274 Okay, well, maybe a smarter person would've figured that out. 180 00:12:38,600 --> 00:12:42,036 Then again, a smart person wouldn't have backed the car into a pole. 181 00:12:42,280 --> 00:12:45,272 A smart person would've realised that it was a $1,200 pole. 182 00:12:45,480 --> 00:12:49,837 That's because smart people don't do stupid things, only stupid people do. 183 00:12:50,000 --> 00:12:52,719 - Phoebe, I didn't mean to upset you. - I know. 184 00:12:53,080 --> 00:12:56,277 - Maybe we should just talk later. - Okay. 185 00:12:57,560 --> 00:13:00,677 - You sure you're gonna be okay? - Yeah. Why? 186 00:13:00,840 --> 00:13:03,479 Phoebe, I know you think getting this job is the answer, but please, 187 00:13:03,640 --> 00:13:06,438 - just don't do anything... - What, stupid? 188 00:13:06,600 --> 00:13:09,672 No, just don't do anything I wouldn't do. 189 00:13:11,880 --> 00:13:13,677 Don't worry, I won't. 190 00:13:17,360 --> 00:13:19,669 You would never cast a smart spell. 191 00:13:20,920 --> 00:13:21,955 Okay. 192 00:13:24,400 --> 00:13:27,756 For 24 hours, from 7 to 7, I will understand all meaning 193 00:13:28,040 --> 00:13:33,717 of the words from here to heaven. 194 00:13:42,680 --> 00:13:45,831 Spirits, send the words From all across the land 195 00:13:46,000 --> 00:13:49,390 Allow me to absorb them Through the touch of either hand 196 00:13:49,560 --> 00:13:51,630 For 23 hours, from 7 to 7 197 00:13:51,800 --> 00:13:56,351 I will understand all meaning Of the words from here to heaven 198 00:13:57,040 --> 00:13:59,508 Oh, and P.S., there will be no personal gain. 199 00:14:17,120 --> 00:14:20,317 Abaca, strong fibre obtained from a banana leaf. 200 00:14:20,480 --> 00:14:24,473 Zygote, a cell formed by the union of two gametes. 201 00:14:27,080 --> 00:14:28,672 Cool. 202 00:14:33,120 --> 00:14:36,430 - Hey, Joe, that was fast. JOE: No line at the x-ray machine. 203 00:14:36,640 --> 00:14:38,756 So did the x-ray confirm its authenticity? 204 00:14:38,920 --> 00:14:41,354 It did a lot more than that. Check out the x-ray. 205 00:14:41,520 --> 00:14:43,715 It's got definitive underwriting on the canvas. 206 00:14:44,200 --> 00:14:47,033 - It has a pentimento? - Yeah, I couldn't believe it either. 207 00:14:47,280 --> 00:14:50,636 But you can see it on the x-ray. The text is in Latin. 208 00:14:50,840 --> 00:14:53,308 I've never seen anything like it before. 209 00:14:53,640 --> 00:14:57,872 "Absolvo, amitto, amplus, brevis." 210 00:14:58,240 --> 00:15:03,394 - To free what is lost say these words. - Wow, you speak Latin? 211 00:15:04,160 --> 00:15:08,039 - Yes. Good night, Joe. - Okay. 212 00:15:08,240 --> 00:15:10,595 Well, why don't I just return the painting to the vault, 213 00:15:10,760 --> 00:15:12,034 say, tomorrow. 214 00:15:12,240 --> 00:15:14,117 - Good idea. - Okay. 215 00:15:25,600 --> 00:15:27,192 "Help." 216 00:15:31,760 --> 00:15:33,557 Okay. 217 00:15:36,680 --> 00:15:40,958 "Semper mea." Mine forever. 218 00:15:43,400 --> 00:15:48,030 Absolvo amitto amplus brevis. Semper mea. 219 00:15:51,600 --> 00:15:53,033 Oh, no. 220 00:15:54,000 --> 00:15:55,831 Oh! Oh! 221 00:16:12,720 --> 00:16:14,597 [GASPING] 222 00:16:17,040 --> 00:16:18,837 Who's there? 223 00:16:19,880 --> 00:16:20,869 [SCREAMS] 224 00:16:21,040 --> 00:16:22,837 - Quick, follow me! - What? 225 00:16:23,040 --> 00:16:25,076 This way. Ladies first. 226 00:16:27,280 --> 00:16:28,918 I see you read Latin too. 227 00:16:29,200 --> 00:16:30,679 Okay, what has happened? Where am I? 228 00:16:30,840 --> 00:16:32,353 - You're in the castle. - Where is that? 229 00:16:32,520 --> 00:16:35,432 - Inside a painting. - I'm trapped inside a painting? 230 00:16:35,640 --> 00:16:38,108 Yes, and if you don't get to that bookcase, you're dead. 231 00:16:38,920 --> 00:16:40,353 Who are you? 232 00:16:40,600 --> 00:16:43,398 My name's Malcolm, and you were supposed to help me, not join me. 233 00:16:43,600 --> 00:16:44,589 Who are you anyway? 234 00:16:44,760 --> 00:16:46,478 My name is Prue, and I was helping you. 235 00:16:46,640 --> 00:16:49,837 - You were supposed to come out. - Great, now we're both trapped. Hurry! 236 00:16:52,880 --> 00:16:54,950 What the hell? What are you? How'd you do that? 237 00:16:55,160 --> 00:16:57,879 Oh, okay, never mind. We're gonna get killed. Will you hurry up? 238 00:17:04,040 --> 00:17:05,029 [MEOWING] 239 00:17:05,200 --> 00:17:06,952 Hi, Phoebe. You're up early. What's up? 240 00:17:07,120 --> 00:17:10,874 Oh, the Dow Jones, housing prices and the space shuttle Discovery. 241 00:17:11,040 --> 00:17:14,032 - Huh? - Read the paper. 242 00:17:14,280 --> 00:17:16,919 Oh. Um... 243 00:17:17,080 --> 00:17:19,116 - Have you seen Prue this morning? - Not yet. 244 00:17:19,320 --> 00:17:21,959 Oh, Dan just called, said he'd meet you at the club at noon. 245 00:17:22,360 --> 00:17:23,634 Okay. 246 00:17:23,840 --> 00:17:26,354 - Did you hear her come in last night? - Nope. 247 00:17:26,800 --> 00:17:28,711 PIPER: This is really strange. 248 00:17:28,880 --> 00:17:29,915 [CAT MEOWING] 249 00:17:

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Última atualização: 2016-04-06
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Inglês

Conversation with my midwife A few months ago, the midwife I used for Dio’s birth invited me to come to her office and meet a CNM she was thinking of adding to her practice. (Having a solo home birth practice is very demanding. Adding a second midwife would allow her to actually take vacations more than once every few years, to do more well-woman care, and to have more time for breastfeeding support as an IBCLC). Here are some recaps from our conversation. My midwife Penny and the prospective midwife Holly talked about their backgrounds and how they came to both midwifery and home birth. Both worked as OB nurses for many years before they even thought of midwifery or home birth. Both eventually pursued a CNM degree with the intention of opening a home birth practice. Penny worked for several years in a large university hospital. It was the end-of-the-line for obstetrical cases, where you’d go if a high-risk situation arose in a smaller, less-equipped hospital; if you needed care for a 26-weeker; if you had an extremely complicated obstetrical history. Penny’s time working at Large University Hospital (LUH) taught her the limits of what medicine could do. Sometimes they could save lives and improve women’s and babies’ health. But other times—all too often—all they could do was offer compassion and support, unable to save every life or prevent all bad outcomes. And this was at the most tertiary of tertiary centers. Penny said that working in such a high-tech, high-intervention setting gave her much more confidence to pursue a second career as a home birth midwife. She knew first-hand what the most advanced medical care could and could not do. There was no mystery or mystique about what a hospital could offer—something she sees as a great advantage, compared to many home birth midwives who have never worked intensely in a hospital environment. During her years as a nurse at LUH, Penny loved taking care of home birth transfers. She was able to offer excellent care for the specific medical issues that needed addressing, while otherwise supporting and facilitating the woman’s desire for a gentle, unmedicated birth. I remember her telling me the story of catching one woman’s baby in the bathroom and putting the baby immediately on the mother’s chest—something she thought entirely commonsense, but something she got a lot of flack for from her co-workers. It was these experiences that pushed her to become a midwife. Penny highly values the knowledge and skills she acquired as an OB nurse in a high-risk setting. She is totally fluent in inserting IVs, administering medications, intubating, resuscitating, etc. Now, she hardly ever uses these skills as a home birth midwife, because they are rarely, if ever, needed. (In fact, one skill she says is becoming rustier than she’d like is suturing, because women in her practice hardly tear, and if they do it’s rare that the tears need stitches—something she attribute to her hands-off approach. Dads or moms usually catch their babies; she steps in only if they do not want to catch or if neither parent is in a good position to do so.) But if/when her medical skills are needed, she is really, really good at them. While we were chatting with Holly, Penny said to me, “you know Rixa, because of your background with unassisted birth, you hired me for different reasons than many women typically hire a home birth midwife. You didn’t need me so much for labor support or guidance. You really hired me for that 5% chance of needing really skilled medical assistance, something that I can do really well.” I thought about that and realized that I agreed with her. I am really independent and pretty much labor and birth all on my own. I don’t rely on my husband or female companions for labor support or encouragement. In fact, I prefer to do things on my own for the most part. So I wanted a midwife not for the 95% of stuff that she does during labor—now, that 95% is quite valuable and many women love the support and guidance their midwife offers during labor—but for the small chance that I’d need some kind of additional intervention or emergency skills. Which brings me to another point I want to make—the more exposure I have to midwives, the more I realize how credentials and background do NOT translate into a certain style of practice. I have a lot of experience interacting with “lay” midwives, direct-entry midwives (CPMs), and home birth nurse-midwives. A CNM degree does not mean that a midwife will have a more “medicalized” style of practice (although it is true that most nurse-midwifery programs are geared towards preparing midwives to practice in a hospital setting). Now, I am sure some people reading this are thinking, “Oh, Penny is such a MEDwife!” But nothing could be farther from the truth. She is very professional and very highly skilled. Very respectful of women’s desires at birth. She had such a quiet presence at my birth that I hardly noticed she was there; she honored all of my requests and wishes that we had talked about prenatally. She was especially adamant about not disturbing the immediate postpartum period. She doesn’t care about liability and has deliberately chosen to forego malpractice insurance and go “bare.” She is willing to go beyond the “standard of care,” to borrow a phrase from Dr. Denise Punger. Her attitude is “you need to prove to me why you shouldn’t have a home birth.”

Indonésio

gogle translete Indonesia ke inggris

Última atualização: 2016-03-15
Frequência de uso: 2
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Referência: Anônimo

Inglês

everything started to go bad between us. We started fighting more, and it was right around January that all hell broke loose. He was the most popular guy in our grade, and he was hanging out with bad friends (in my opinion). It started to go to his head, and he soon became a faint shadow of what he was before. We started fighting over everything; we couldn't have a simple conversation without it ending badly. He started putting me down, calling me things like 'ugly' and a bitch. I had days where I really believed what he was saying; that's how much of an impact he had on me. In February, I told him that I liked him. I had already told him in November, but I guess it didn't sink in before. He verbally destroyed me. I remember coming home and crying for 20 minutes (it doesn't seem like a lot, but for me, I kinda cry intensely). I cried because he had said some things to my friend that he wouldn't say to my face, and she had to tell me. In the middle of March, he moved to the northern part of the state, and it still broke my heart even though our relationship had sucked so much before. He's coming back on June 1st, and I'm so happy, even though he hurt me so badly. Life is just messed up sometimes, isn't

Indonésio

This is my life

Última atualização: 2013-11-04
Frequência de uso: 1
Qualidade:

Referência: Anônimo

Inglês

everything started to go bad between us. We started fighting more, and it was right around January that all hell broke loose. He was the most popular guy in our grade, and he was hanging out with bad friends (in my opinion). It started to go to his head, and he soon became a faint shadow of what he was before. We started fighting over everything; we couldn't have a simple conversation without it ending badly. He started putting me down, calling me things like 'ugly' and a bitch. I had days where I really believed what he was saying; that's how much of an impact he had on me. In February, I told him that I liked him. I had already told him in November, but I guess it didn't sink in before. He verbally destroyed me. I remember coming home and crying for 20 minutes (it doesn't seem like a lot, but for me, I kinda cry intensely). I cried because he had said some things to my friend that he wouldn't say to my face, and she had to tell me. In the middle of March, he moved to the northern part of the state, and it still broke my heart even though our relationship had sucked so much before. He's coming back on June 1st, and I'm so happy, even though he hurt me so badly. Life is just messed up sometimes, isn't

Indonésio

i love

Última atualização: 2013-08-27
Frequência de uso: 1
Qualidade:

Referência: Anônimo

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