In the belly of the beast

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.

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