Belly Tales

Last week I had an exam in Neonatology, and my teaching project and a presentation in Neonatology all due at the same time, so it was a bit hectic. This week, the only thing on my plate is a few modules and some studying for the upcoming final exams, and a write-up of my teaching presentation, so I’m taking a justified, (albeit brief) break, and blogging for a delicious change.

I was looking back over some of the posts I’d written about hospital birth over the past year and a half, and I feel that the time has come to eat some crow. Not a huge amount of crow—not a grilled crow steak with onions and salad and the works, but maybe a crow kebab or crow pie appetizer. I think I was feeling very burned out this past summer, very very tired of all of the hospital birth BS, and I think a lot of that had to do with how very tired I was of working as a nurse. I was (and am) ready for change, and ready to be working as a midwife, and now that I’m actually more than halfway through my IP clinical rotation, and am finally (FINALLY!!!) catching babies, it’s as if a large piece of the puzzle has fallen into place. Suddenly, everything feels right in the universe, and I’ve been so ridiculously happy lately, now that I am actually doing what I have wanted to do for so long—this glorious, miraculous, beautiful work that has called to me for over 5 years now. So, the burned out feeling is gone, and in it’s place is a refreshing sense of growth, because I am learning so much right now, and heading in such a fantastic direction, and things finally feel like they’re moving. It’s slowly dawning on me that school will in fact be over (probably much sooner than I’m ready for), and that I will indeed be a midwife someday (really, truly!!).

The point being, the hospital where I’m currently doing my clinical rotation flips a lot of the hospital-birth stereotypes on their heads, and maybe this has a lot to do with the fact that midwives are employed by this hospital, and respected by this hospital (and the OB Dept., which says a lot right there), and do a lot of the work of running the labor and delivery floor. I can only write from my experience, and this is what I’ve seen: 3 years of working as an L&D nurse in two seperate hospitals, and I’d say that at least 90% - 95% of all births involved an epidural. A woman without an epidural was either making a huge and difficult point to labor “naturally”, or had simply managed to show up to the hospital fully dilated and unable to recieve one in time before she delivered. I can’t say that the majority of births I’ve seen have had at least a 1st degree laceration, but I do feel that at work, an intact perineum is often a rarity, and a very pleasant surprise. Women, as a rule, are not allowed to eat or drink during labor. The squat bar often sat gathering dust in a corner, the birthing balls were rarely (if ever) used, and getting a woman out of bed was always a very rare and unexpected treat, that often required a lot of fighting for. It was never the norm.

And this is not to say that there are no fights to be fought at the hospital where I am currently doing my clinicals, but I’ve been paging through my delivery book (21 births so far, believe it or not!!!) and noticing that more than halfof the woman I’ve worked with haven’t had any analgesia or anesthesia on board (14 out of 21, to be exact). The majority of them have had intact perineums. I’ve used the squat bar more times in the past 7 weeks than I have used it or seen it used in the past year at the hospital where I’m working. The women on the floor are almost always given clears to drink, which is a much better deal than being NPO (i.e., not allowed to eat or drink anything), and some women are even allowed to eat some lunch in the early part of their labor or induction. And while getting a woman out of bed still causes a lot of eyebrows to be raised, I’ve seen it happen at least 4 times so far, and once we even got the woman out of bed, off the monitor, and into the shower, where she would have remained if only someone could have stayed in the room with her to fend off the anxious nurses trying to get her back on the monitor.

Oh, and VBACs! Did I mention that this hospital does VBACs? And not just attempted VBACS, but actual, squalling-baby-born-vaginally type VBACs?? Very very pleasant surprise. I think I can possibly count on one hand the number of successful VBACs I’ve seen at Tried and True Hospital.

And have I mentioned lately how much I’m enjoying my clinical rotation so far? And these births!! All these beautiful births!! I’ve caught so many babies so far! I feel so blessed, and so lucky, despite the exhaustion and over-worked brain and tired legs and mounds of homework. I stayed late one night and caught three babies in a row, one right after the other—women I’d been laboring with all day, and had been examining all day, and watching as their cervixes changed from 2 cm to 6 cm to fully dilated, and was then lucky enough to be able to catch all of their babies. Afterwards, at around 2:00 in the morning, as I was finally leaving, I stopped by the postpartum room of the first woman I had delivered that night (she was a successful VBAC!!) to say goodbye. She had been wearing a gorgeous woven cloth rosary around her neck throughout her entire pregnancy and birth, and she pulled it off and gave it to me, and I walked down to the lobby with tears in my eyes, cradling the beautiful rosary. It is such an honor, and such a gift, to be able to be with women at the moment of their births, and to be able to catch their babies. Some days I can’t believe my luck and good fortune, because that’s really what it feels like to me. I am such a lucky woman! This really is the best job in the world.

Wow, this really makes my blood boil: a woman was recently kicked off of a Delta airline because she was breastfeeding her daughter. Isn’t it hard enough traveling with young children without being penalized for trying to feed them? Sheesh! It’s high time Congresswoman Maloney’s Breastfeeding Promotion Act was passed. Please take 2 minutes and sign a petition to Delta Airlines in support of breastfeeding women, and while you’re there, check out the very cool Momsrising.org. This anti-breastfeeding behaviour seems rampant lately, and is cropping up all over the place: Starbucks, Toys ‘R Us, now Delta. If you have a moment, take the time to tell your Senator that NOW is the time to get moving on the Breastfeeding Promotion Act. I still don’t understand why this bill hasn’t passed already: it’s all about the health of moms and babies. Isn’t that a politician’s bread and butter? What’s not to like? Jeeze louise.

You’d think that by now I’d be good at this whole advocating for women/ advocating for myself thing, but I’m not. It takes practice, and it’s really depressing when I’m unable to find the personal power, the chutzpah, the whatever it takes, to actually say what needs to be said. A case in point:

A few months ago, during the summer, when I was working in postpartum one night, I was taking care of a woman who’s partner seemed to be completely checked-out of their relationship. He refused to respond to the woman’s repeated attempts at engaging him and getting him to help participate in baby care, or even pay attention to her and the baby in the first place. Often as a nurse I get the privilege of teaching both parents so much about their amazing newborn, and about breastfeeding and baby care, and often the fathers are just as eager to learn and help as the mothers. Not so in this case. And it was almost pathetic, the way she kept calling his name over and over, trying to get him to look, to pay attention, to help, to see, while instead he watched TV, and then eventually rolled over, turned his back on his wife and baby, and went to sleep. I was rather shocked by it, and went out of my way to help the mother take care of her newborn that night, while the husband slept on. I think I was hoping he’d see my efforts and realize that a) his wife needed help and b) he was doing absolutely nothing, and then begin to help, out of embarassment if nothing else. This didn’t work, obviously. The husband didn’t stir throughout the night, didn’t help his wife with the 3rd degree laceration walk to the bathroom, didn’t get up to check on the baby when it was screaming through the night (and in fact, how in the world do you SLEEP with a screaming baby in the same room??). The mother was very needy, wanting to breastfeed, lacking confidence in herself and her abilities, and desperate for praise and attention. I spent a lot of time in that room, and she stayed up for most of the night, while her husband slept. I could imagine how exhausted she’d be in the morning, and was worried about how little help and support she’d receive from him, and it turned out that I wasn’t the only one who was concerned! The nurse who’d taken care of the couple the night before confirmed that the husband’s behaviour had been just as unsupportive during her shift as well, and that there was definitely something “not quite right” about the way they related to one another (or failed to relate). Couple this with the fact that this woman had a history of depression, and it was almost like we were staring at a major case of postpartum depression just waiting to happen.

So, what did I do about it? I mentioned my concerns to woman’s attending doctor the next morning, and was flatly dismissed as being ridiculous and out of line. The doctor told me he knew the husband well, and had seen him at many prenatal visits, and was sure that not only was the husband supportive, but that the woman would be fine. When I suggested that we call social work, he told me absolutely not. When I mentioned her history of depression, he again stated that he was sure she would be fine, and that obviously what I had seen and observed was not what was really going on. He defended the husband again, said that maybe he was just tired and worn out from supporting his wife through labor, and that was that. No consults were made. No referrals were given. I felt absolutely helpless, but the way consults work in my hospital, only a doctor can order them, not a nurse, and what could I do? And frankly, I’m not so sure this woman needed a social work consult anyway—she didn’t need WIC or public assistance or anything like that, she just needed support!

I turned my patient over to the day nurse at the shift change, telling her about what I and the other nurse had observed, and then I went home, feeling shamed and belittled by the doctor, and feeling hurt and angry and pissed off and frightened, and alternately wanting to scream at the doctor, but also somewhat wishing I hadn’t opened my mouth, so thoroughly had I been shot down.

And where is that woman now? How is she doing? Who’s checking up on her? Has her partner become any more supportive, or is she feeling like she’s all alone in the world, with a new baby, absolutely no help at all, and ready to climb the walls? Did we let her down? Did I fail her by not taking a firmer stance with Dr. Belittle?

We had a very moving lecture on Postpartum Depression a few weeks ago, and of course this incident with Dr. Belittle and the scary unsupportive husband immediately came to mind. I wish I had had this lecture before above said incident, instead of 3 months after the fact. It was really driven home to me just how poor our country is at recognizing this disorder, let alone offering the appropriate resources and treamtent to the women who so desperately need support during such a terrible, vulnerable time. And as a nurse who occassionaly works on a postpartum unit, I’m amazed that I, personally, in the role of the nurse (i.e. someone who is supposedly trained to recognize signs of this, and to intervene with the appropriate support and treatment when necessary)…I had NO idea where to send a woman like this. No idea how to get in touch with support groups or hotlines. No resources to give this woman. No idea of who to call. No idea what referrals needed to be made (and as a nurse, my ability to refer is limited, since nurses can’t make referrals, but as a midwife, it’s a whole different story). Neither did the other nurse. We both felt something should be done, but we didn’t know what to do. Hello?? Shouldn’t the hospital have provided us with info and resources for this very situation? Where are nurses supposed to get this information from if it’s not part of their training? Why aren’t these resources more readily available? While the idea of routinely screening women for PPD as part of a nurse’s training/ job (let alone a doctor’s!) is given lip service, in practice, it isn’t really that routine. Isn’t that more than just a little scary??

I think in general people are so uncomfortable with diagnosing and treating and accepting psychiatric illness that we’d rather look the other way and pretend it doesn’t exist, rather than confront it. And I think a lot of this also stems from the fact that so often as providers, we really don’t know where to send women so that they can get the help they need, aside from the truly drastic measures like psych consults and social work consults (a route which Dr. Belittle clearly didn’t want to take). Maybe the new postpartum depression bill that’s recently been proposed in Congress will help with recognition and treatment of PPD, because any help at all in this depeartment is sorely needed!

Anyway, to make a long story short, the lecture was fabulous. The presenter was an RN who had personally experienced PPD herself, and was incredibly passionate about the subject. She had references and resources coming out the wazzoo, and I’m now very pleased to be able to pass all of this information on to you, my loyal readers, as well as to know that next time I see something like this (as a nurse or midwife), I will know exactly where to send the at-risk woman. And I’ve started incorporating signs and symptoms of the Baby Blues and PPD into the teaching and educating I do when I’m working on postpartum. And, I’m kinda hoping I get another opportunity to bring an at-risk patient to the attention of Dr. Belittle, because not only will I now be prepared to tell him exactly where to go if he starts to belittle me again, but I also feel like have the tools I need to actually educate him. He wasn’t the one staying up all night with that woman. He should put more faith in a nurse’s judgement, because after all, we spend a hell of a lot more time with the patient than he does. Doctors of the world: ignore nurses and their insights at your own peril, because they see things you’ll never see during your 15 minute antepartum visit or your 10 minute rounding!

Every time I’m forced to stand up for myself, I get a little bit better at it: a little calmer, a little more grace under fire, and a little more articulate.

Postpartum resources:

1-800-PPD-MOMS

1-800-944-4PPD (4773)

Postpartum Support International

National Association of Mothers’ Centers

The Postpartum Resource Center of New York

I’m running off to class this morning, and I do apologize for the severe lack of posting that’s been happening around this place, but here’s some quick news for all of you:

First, the people of South Dakota have spoken loud and clear when it comes to more restrictive abortion legislation.

Women’s Health News has a lovely break-down of the newly proposed Pregnant Women Support Act, which proposes to increase funding to gather more complete information about the reasons women choose to have an abortion, offer assistance to women carrying thier pregnancies to term, and strengthening informed consent options when women choose to have an abortion. The initative is designed to help support women facing unplanned pregnancies, new parents and their children by providing comprehensive measures for health care needs, supportive services and helpful prenatal and postnatal services. Nevertheless, as Women’s Health News points out, there are still a lot of flaws in this legislation: for one thing, it doesn’t actually greatly increase the amount of financial support women will recieve during their pregnancy, let alone assistance they’ll receive while trying to raise a child—which is no small thing, given that the second most frequent reason cited for having an abortion is “can’t afford a baby”. And of course, while this legislation aims at reducing the number of abortions, there’s no funding for contraceptive education or a more comprehensive sex education curriculum. I also agree with Women’s Health News: wouldn’t it make sense to study the reasons for abortion first, before trying to reduce the number? We’ll have to keep our eye on this.

Finally, this is older news, but I’ve been meaning to post about this for awhile now: New Jersey sent a strong message to the federal government by choosing to reject federal funding for abstinence-only education, which demands very tight requirements on sex education in return for funding, including requiring that teachers say that sex within marriage is the “expected standard of human sexuality” and not allowing them to talk about contraception in the classroom. Way to go New Jersey!

And finally, three words: Hallelujah, go Dems!