Belly Tales

Or actually, something in the air (well, the barometric pressure, anyway). Our unit was absolutely slammed last night. I had 2 deliveries myself, and two admissions, which is a lot of work, especially given all the paperwork and charting and documenting required. We had 11 deliveries total over the course of our 12 hour shift; that’s almost a baby an hour, and is doubly impressive given that we only have 10 LDRs (labor/delivery/recovery rooms) on our unit. And of course, this wasn’t counting our antepartum patients, or the women who didn’t deliver. It was a madhouse. Every room was full. Women were pacing in the hallways. We could barely get the rooms cleaned fast enough before the next admission was walking in.

More remarkable, though, is the fact that this wasn’t just a freak occurence at a single hospital in NYC. I spoke with a friend who is a nurse in L&D at another hospital, and her unit was overflowing as well. I’d say we are witnessing some of the untold effects of Hurricane Katrina. The weather here is humid and rainy now as the hurricane dissipates up the coast. The same storm that’s ripping the roofs off of buildings in Louisiana and Mississipi is merely dumping rain on those of us up north, but even so, the drop in the barometer has been enough to send women into labor. Surely there’s research on this phenomenon? Or is this just a truth that midwives and nurses know? I’ve never had a chance to investigate. All I know is that whenever there’s a change in the weather, womens’ water is breaking all over the city. Full moons are the same way. Even if there isn’t any research to back all of this up, it’s certainly something I’ve observed with my own two eyes, which makes me tend to believe it as true.

Pretty neat, huh? Yeah, I think so too. The cyclical nature of labor and birth has always amazed me.

Check this out: Student Midwives Sanctuary

Absolutely brilliant. Especially the forum.

Go there. ASAP.

And, why don’t we have something like this for midwifery students in the US????

*ponders*

Davis-Floyd, Robbie. 2003. Birth As An American Rite of Passage (2nd Edition). Berkeley and Los Angeles: University of California Press.

So, I’ve been reading this book pretty much non-stop for the past few weeks, and I have been completely blown away. C o m p l e t e l y. This is the book that finally answers the maddening question “WHY????”. Why does modern obstetrics insist upon the use of routine and often unecessary interventions, even when evidence-based research has shown that these interventions often do more harm than good? Why does the practice of modern obstetrics place the obstetrician and hospital staff at the center of the delivery, rather than the woman and her family? Why do so many women collude with a system that so fundamentally disempowers them at every turn, not only allowing these obstetrical interventions to be performed upon their hapless bodies, but doing so with nary a protest—instead, with smiles of gratitude and profuse thanks?

The answer, it would seem, lies in ritual. (Read on …)

I was browsing in the Midwifery Today forums earlier this evening and I found the most amazing link: a homebirth midwife has actually taken the time to photograph (in great detail) all the contents of her birth kit. The entire thing is beautifully organized and documented, and very illuminating. For quite some time now I’ve known that someday I want to be a homebirth midwife, but I have never yet stopped to think about all the details that will entail: the supplies, the equiptment, the O2 tanks, the organization, the mode of transportation. This link makes it much more real, and much easier to imagine (and it does look like she has a good system—certainly something worth studying and possibly imitating), but oh man! The task of putting together a birth kit seems a bit daunting. Fun, certainly, to shop for all of those supplies and assemble your first kit, but what a ton of stuff that must be acquired! Three enormous bag-fuls! Thank goodness this is still many, many years down the road for me. I can’t even begin to wrap my head around it right now, let alone afford it, but it’s nice to catch a glimpse and get a rough idea of what is going to be needed, further down the line.

The short-short version: Miles For Midwives is an annual 5K run/walk that happens every October to raise money for the creation of a new independent birth center, as well as the local ACNM chapter in NYC, so here’s your first official heads-up. Miles for Midwives also coincides with Midwifery Week, and is a great opportunity to raise public awareness about midwifery and all of the benefits it has to offer. So, put it on your calendars and drag out your running shoes. New York City will have a free-standing birth center again, someday. Hopefully someday soon.

The longer version: Let me share a sad story. Once upon a time (Read on …)

I got my first letter yesterday regarding the upcoming semester, which starts the first week of Sept (and there was much rejoicing!!!). The letter was from the professor who will be teaching my first Research module, and included a somewhat lengthy list of all the books I need to buy, which is much less exciting, given the current state of my bank account at the moment:

Nursing Research: Principles and Methods
An Introduction to Research for Midwives
Linking Research and Practice in Midwifery
Statistical Methods for Health Care Research

Fun fun.

The letter also included my first assignment: I need to start to think about a research question which piques my interest and is something I’d like to potentially work on during the course. So, any suggestions for scintillating, controversial, saucy research topics for the coming semester? I’m going to have to mull this one over for awhile.

However, expensive books aside, midwifery school is on the horizon again. I can’t wait!

It has come to my attention that last week…well, nearly two weeks ago, now…was World Breastfeeding Week, brought to you by the World Alliance for Breastfeeding Action. *Sheepish* I feel like I should have been on top of that one, but somehow let it slip through my fingers (it was, to put it mildly, a busy week for me). Anyway, the point is rather moot, since EVERY week should be world breastfeeding week. Breastfeeding is the healthiest food you can possibly feed your baby! It’s an organic, living mix of antibodies, brain-cell promoting cream, nutrients, minerals, immunoglobulins…basically, EVERYTHING your baby needs to stay healthy and grow strong. And it’s constantly changing. Can you believe that? If your baby needs more of one kind of nutrient over another, or a higher fat content, or is dehydrated and needs more water, the quality of your breastmilk will actually change to meet these needs. Breastfeeding is a complete meal for the baby: at any given feeding, the first 60% of the milk suckled (called the foremilk) is like skim-milk, hydrating and watery; the next 25% is whole milk, full of protein and antibodies, and the final 5%—called the hindmilk—is pure cream, full of fat for growing brains, and taaaaaaassty (it’s dessert). Babies who breastfeed have fewer allergies, tend to grow bigger and get sick less often, have a much lower incidence of asthma, and studies have even linked breastfeeding to higher intelligence. And that’s just the physical stuff! Don’t forget about the improved bonding and nurturing your baby receives, teaching him or her that the world is a safe, secure place, and that he or she can trust. That’s a mighty strong foundation upon which to lay your baby’s future emotional growth. So, in conclusion, breastfeed! And encourage your friends to breastfeed. And support the breastfeeding women in your life!

To honor World Breastfeeding Week (and since this site is desperately begging for some art), I’ve culled the internet for some kick-ass images of breastfeeding, mostly courtesy of Breastfeeding.com. (Credits have been given when I could find someone to credit.)

(Mattia Pretti)

(Piccasso)

(Edouard Debat-Ponsan)

(Mary Cassat)

I’ve been writing a lot of political posts lately, so I thought I’d post about something completely personal instead, for a refreshing change of pace. I have just recently switched jobs. I worked in Labor and Delivery at a large metropolitan hospital for 1.5 years (which I will refer to as Tried and True Hospital, for the purposes of this post), and now, as of tomorrow, I will be working for a different, somewhat smaller metropolitan hospital—let’s call it New Hope Hospital. I switched jobs because I need a part-time or per diem position to accomodate my school schedule, and Tried and True didn’t have any part-time openings for me, and a strange aversion to letting me work per diem. I had to jump ship and find a new job because I’m going back to school full-time this fall to become a midwife and nothing (NOTHING!) is going to get in the way this time, least of all my nursing “career”. This is my third attempt at midwifery school, after two false starts; amazing how easy it is for life to get in the way of your education. Well, no longer!

Anyway, as with any big life decision, this has its pros and cons. On the one hand, the flexibility will be fantastic, as well as the freedom to plan my own schedule, and I’m looking forward to the fresh start. New Hope hospital has different policies, different protocols, different IVs and solusets and infusion pumps and FHMs and computer charting, different everything, and the new experience will do nothing but make me a better nurse. However, on the flip side, this means making new friends, learning a brand new system, feeling like a complete fish-out-of-water for a few months, making lots of mistakes, getting snapped at by the grouchy old nurses who are always mean to the new ones, and generally feeling uncertain and incompetent, all of which is predictable but never much fun.

The one thing I’m really concerned about is how demoralizing working at New Hope might be for me, from a philosophical standpoint. Which is not to say that New Hope isn’t a good hospital—it is. But Tried and True had an in-house birthing center and a philosophy towards birth that more closely jived with my own (although it was still a hospital, full of unnecessary hospital interventions, and your typical 25+% cesarean rate). Midwives had admitting rights at Tried and True, and there were lots of women coming in with their birthing balls and doulas, hoping for as natural a birth as possible. My attitude and support was able to make a big difference at Tried and True, mostly because the women giving birth there were open to the kind of support I wanted to offer them. Sometimes I was able to prevent an epidural from happening. Other times, even when interventions were being performed which the woman hadn’t wanted, I was able to help her accept them and not feel like a failure, and be present and joyful at her birth instead of feeling disempowered and disappointed (it’s amazing how powerful a simple “this is not your fault” can be). One of the most gratifying parts of my job was the tangible difference I felt I was making in the quality of my patient’s births, even if it was just something as simple as haggling with a doctor so that she could have “ambulation orders” (i.e. be allowed to walk around, which helps with the pain and takes advantage of gravity, which is, of course, a woman’s best friend while in labor), or arguing against NPO (i.e. not being allowed to eat), so that the woman could eat and keep her strength up, instead of relying on an IV. Small things, but every one of them felt like a tiny victory.

The Nurse Manager at New Hope is an outspoken, brassy woman, and I like her already. She was very up front with me about New Hope during my interview, even stating at one point that nearly everyone got an episiotomy, and if I was looking for beautiful, natural births, this might not be the hospital for me. New Hope is a hospital’s hospital. It schedules 3 elective cesareans a day. Apparently the women come in at one centimeter dilated demanding their epidurals. It seems as if very few are interested in natural birth (although there will be some, of course! Just few and far between). The cesarean rate at New Hope runs somewhere in the 30+% range. I don’t think the majority of these women are going to be as open to the kind of support I’d like to offer them as they generally were at Tried and True.

Still, I knew what I was getting into when I took this job. I’m probably not going to be able to make much of a difference at New Hope, but I’ve got to keep in mind that this isn’t my dream job or dream career. This is just what I’m doing to pay the rent while I’m in midwifery school, and learn even more about the appalling hospital system in the process. My biggest fear is that I will slowly become indoctrinated into the values and beliefs of that system, despite my best efforts not to. I feel a bit as if I am entering into the belly of the beast…but I am doing so consciously, with my eyes open, and that makes a difference, doesn’t it? Labor and delivery is not the right time to challenge a woman’s attitudes towards birth. This is a job, and I’ll do my job. If the women schedule their cesareans and demand their epidurals, I’ll support them in their decisions, and work to make sure they’re as satisfied as possible with the choices they’ve made (and try to slip in as much private bonding time, and skin to skin contact, and breastfeeding encouragement as possible, etc. etc.). The beauty will still be there, even if it’s buried under thick, thick layers of hospital intervention; I will have to learn to look harder in order to see it.

I have to just keep repeating to myself: this is all about the flexibility of per diem, which will allow me to plan my life around SCHOOL, and make midwifery and my eduction my absolute priority. If the job is less than ideal, well…I’ll cope. That’s the plan, anyway.

Just a few follow-up articles about Governor Pataki’s shameful veto of the Emergency Contraception bill yesterday:

Choosing When to Be a Mother Hen

Both Parties Attack Pataki’s Stand on Morning After Pill

Pissed off about it? Contact Governor Pataki!

Wondering what else you can do? Join NARAL New York.

Midwifery in the news: check out the latest article by Anemona Hartocollis on men in midwifery (specifically, Richard Jennings, a midwife who practices at Bellvue), in last week’s NY Times (7/31/05).

To quote a very small snippet:

Many of his colleagues are more ambivalent about his role. “Most of us tend to think of ourselves as being really open-minded and not discriminatory,” said Joan Bryson, a midwife in private practice and chairwoman of the New York chapter of the American College of Nurse-Midwives, a professional organization. “But we’re not sure if we think there should be male midwives.”

Personally, I’m all for it. Sure, it might buck the status quo, but that’s a good thing, isn’t it? Midwifery is a way of caring for someone; it’s a state of mind, an attitude, a belief that birth is safe, that women are strong, that healthcare should be open and patient-driven, that support should be unequivocal, interventions used only when necessary, and all of it done with gentleness and respect. A man can practice this way as easily as a woman, although it’s very rare that men are able to do so. Some people may argue that women are better able to deliver this care because they are women, they have the requisite plumbing, and are therefore much better able to empathize, but then, how do you explain female obstetricians who can’t empathize to save their lives, or female midwives who are amazingly empathetic, but have never given birth themselves? And what about men like Grantly Dick-Read, Michael Odent and Robert Bradley, who have done more to support women, pioneer natural childbirth, and provide gentle, holistic care than many women in their entire lifetimes? True, midwifery has been a traditionally female role, but that’s probably just because women tend to have more of the qualities needed to make a good midwife, thanks to socialization and our ideas of what a “man” and “woman” is, but women don’t have the patent on midwifery. It has nothing to do with gender or personally experiencing birth (although I’m sure that giving birth yourself doesn’t hurt one bit in the empathy department). Instead, it has everything to do with attitude, patience, outlook, communication and fundamental beliefs.

Shouldn’t we be more alarmed about a world where there are so few men out there who are able to deliver this kind of care? Shouldn’t we be more concerned about the way we’re raising our little boys? Why is it surprising to us that a man is able to care for women the way a midwife should? Rather than wondering whether men should be allowed to be midwives or not, we should be wondering why there aren’t more male midwives in the first place.