Like a lot of folks in this state, I have a job. I work – they pay me. I pay my taxes and the government distributes my taxes as it sees fit. In order to get that paycheck, I am required to pass a random urine test with which I have no problem. What I DO have a problem with is the distribution of my taxes to people who DON’T have to pass a urine test. Shouldn’t one have to pass a urine test to get a welfare check because I have to pass one to earn it for them?

Please understand, I have no problem with helping people get back on their feet. I DO, on the other hand, have a problem with helping someone sitting on their ASS, doing drugs, while I work. Can you imagine how much money the state would save if people had to pass a urine test to get a public assistance check?

Pass this along if you agree or simply delete if you don’t. Hope you all will pass it along, though. Something has to change in this country — and soon!

My colleague hadn’t written this e-mail. It was a forwarded chain letter, and all she was doing was forwarding it to the rest of us. She did ask us what we thought about it, though. My initial desire was to dash of an immediate (and very heated) response to everyone on the recipient list. Cooler heads prevailed, however (I am still a very new employee, and I’m not sure how I feel about making enemies this early in the game), but I did want the opportunity to air my thouughts on this. So hello my delicious little annonymouse blog, aka venting-opportunity-extraordinaire.

What do I think about this? Well, I think it’s a very condescending, priviledged and uneducated point of view. It’s an excuse that people make for not having to care as much about “those people who do drugs” or “those people on welfare” or “those people who sit around on their asses doing drugs while I’m working”. While there are always a few people who are bound to take advantage of a system like welfare or medicaid, I don’t think the majority fall into this group. Ask yourself how you would feel if you were receiving welfare–would you be sitting back on your ass, taking advantage of it, and doing drugs? I think many people are embarrassed and ashamed to be on welfare, but unfortunately, the system focuses on the hand-out aspect of it, rather than on teaching and educating and empowering and giving people the tools and resources they need to get off of welfare. I think it creates a system of dependency and complacency, and I think THAT’S what needs to change.

Those of us with good jobs are privileged in so many ways we may not even recognize. How did we get those jobs? Because we have an education. How did we get that education? Because we were blessed with an attitude or an upbringing or a teacher or a mentor or a relative or a friend who believed in us and taught us that education is important, and that it matters. How did we pay for that education? Because we were blessed with scholarships or grants or friends or relatives who could help us out, or banks that had enough faith in our future potential that they were willing to loan us money, and because we were blessed with enough cultural capital to know how to ask a bank for money in the first place. Or because we were blessed with the knowledge that education is worth it, even if it takes you 7 years to pay for every cent of it yourself from your hard-earned paycheck at MacDonalds. How did we get into college? Because we were blessed enough to finish high school; because many of us we weren’t growing up with violence or drug abuse in the home, because most of us had a stable life and a roof over our heads and food to eat and time in the evenings to do homework and someone there who was going to make sure we DID our homework. Of course we had to work for it, and want it, and put in lots of our own hard-earned blood, sweat and tears, but the desire to get where we are right now is something we shouldn’t take for granted, and not something that everyone is lucky enough to have. The “well, why don’t they just get a job?” attitude is a blanket statement of privilege, which fails to acknowledge how difficult it is to obtain a good job, and all the ways that getting an education and therefore getting a good job is a learned behavior, and a cultural gift, and that not everyone is lucky enough to have that passed on to them and instilled in them, especially at a young age.

The other fallacy in this is the fact that drug use is an ADDICTION. What makes people take drugs in the first place? Depression, loneliness, feelings of helplessness and despair? A sense that they’re trapped, that there’s no way out, that life is shit and there’s nothing to do but try to enjoy what little time you’ve got on this earth in any way you can? Trying to belong to a particular group, trying to fit in, trying to feel like you’ve got a community or a family or friends? Whatever the reasons, the decision to habitually use drugs rarely stems from carefree flower-child experimentation or laziness. People who start to use drugs are driven to it because something is pretty damn bad in their life in the first place, and then, once they’ve started….they can’t stop. Hence the ADDICTION part of it.

To make it sound so easy and so simple–I have a job, I don’t use drugs, I take a urine test, so why can’t “those people” do the same?–is a very narrow-minded point of view, and fails to address any of the larger issues; it’s patronising, simplistic and judgemental, at its very core, and because we all know that the majority of people on welfare are certainly not white, it’s also racist at its core. Cutting people off from the help they need by forcing them to take a urine test before receiving public assistance will probably only make things worse, not better, and only addresses the symptom, rather than the root of the problem. The root of the problem is: what is it in this person’s life which drove them to take drugs in the first place, and how can we address that and help that? I don’t believe in free hand-outs either, but drug addiction is not something that people can just stop overnight, no matter how much they might want to (and usually if they’re deep in addiction, they don’t want to anyway), and it’s not something that people can usually do on their own. It’s so easy for the non-addicted to say to someone who’s addicted…well, just stop using, get off your lazy ass and quit doing drugs…but has that person ever stopped to consider just how HARD that is? Have you actually put yourself in the other person’s shoes, and tried to walk a mile in them? Help, compassion, non-judgement and true understanding would go a lot further, in my very humble opinion, than the “get off your lazy ass and quit abusing the government dole” attitude. Respect for “those people” would make a huge difference, too, but if you see “those people” as lazy (and if you see them as “those people” in the first place)…you’re never going to be able to respect them enough to make any kind of positive change.

Where does the midwifery come into all of this? LISTEN TO WOMEN and DON’T JUDGE. Those two lessons, all over again. The respect and the need to be able to put yourself in someone else’s shoes is inherent in that.

Now, the next question is…should I go ahead and send this back to everyone on the e-mail list? What’s it worth? Making a good impression at my new job and not pissing people off right off the bat…or speaking my mind and being upfront and honest about my beliefs, even at the expense of creating work conflict? Aargh, really tough call.

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

[Gillian] Smith [Scottish national officer of the Royal College of Midwives] is heading a campaign by the RCM Scotland to reduce the number of unnecessary interventions women in labour are subjected to. She said: “Is routine electronic foetal monitoring required in every single woman? Perhaps they do not need it. Does that then start a string of interventions because the woman is strapped down and can’t move about?”There is research to prove that a woman who is up and about will labour better.

Our campaign is about trying to encourage midwives not to give in too quickly. Research tells us that women who receive one-to-one care are less likely to need analgesia and Caesareans. There is a tendency to perhaps intervene a little earlier than is actually required.”

According to the article, the cesarean rate in England has doubled in the past 20 years, and is now close to the 25% mark (which is still lower than the cesarean rate here in the US). Many studies have demonstrated that intermittent auscultation in low-risk women with healthy pregnancies is just as effective as continous electronic fetal monitoring, with the added benefit of allowing the woman to move around and not be confined to her bed during labor.

From further down in the article (the naysayers point of view, if you will):

Dr David Farquharson, clinical director for women’s reproductive health at the Edinburgh Royal Infirmary, said the practice of electronic foetal monitoring was standard in his hospital to reassure doctors and patients.He said: “This is a very controversial area. A lot of obstetricians do not feel comfortable not having a record of foetal heart rate when the woman comes into hospital.

“The alternative is the midwife listening with a hand-held device, and that depends on her being confident on hearing it.

“The problem with that is knowing what they are listening to, then counting the beats with a watch. There is always the risk you could be taking the mother’s pulse. That’s a worry to obstetricians.”

That last sentence is the kicker there. I ask you this: would a midwife who is well trained in fetal auscultation, and who probably does it on a daily basis, really be so simple as to confuse a maternal heart rate with a fetal heart rate, or be unable to find the fetal heart rate in the first place? Is their trust in the clinical skills of their midwives so low? Is this really the worry that’s keeping Scottish obstetricians up at night?? Please. Distinguishing the maternal heart rate from the fetal heart rate is often a very simple matter of taking the woman’s pulse at the same time while listening to the baby’s heart—if what you’re feeling in the pulse is matching what you’re hearing in the heart rate, then obviously you’re listening to the mother’s pulse and not the fetal pulse.

Fetoscopes can be just as sensitive as electronic monitors, and in some situations are actually better than EFMs for the simple reason that they don’t produce artifact, and there’s actually a living, breathing, thinking clinician on the other end of the fetoscope. Electronic monitors often have built in computer logic buttons which will try to make sense of a fetal heart pattern that the machine doesn’t understand (for example, if there is extreme tachycardia, some EFMs, not being able to understand a heart rate over 200 beats per minute, will automatically halve the heart rate, and the only way to tell for sure is to actually listen to the heart rate itself, i.e. auscultation.) Fetoscopes are also supposed to be used to confirm the presence of supraventricular tachycardia, to make sure that missed and skipped beats are not artifact appearing on the EFM—we were just taught this in class during our lecture on fetal heart rate monitoring. I think the worry really stems from the fact that more and more trust is being placed in machines, while the skills and critical thinking of experienced clinicans is being devalued in the face of technology. Very few clinicians are even trained to use a fetoscope any more, just like doctors are no longer being trained to deliver breech presentations. Sensitive, important skills are being lost to newer generations of practitioners, so that now the standard has become cesarean cesearean cesarean, sometimes because doctors no longer have the skills to do anything but.

I wonder if England can begin to limit the use of EFM, will America follow it’s lead? In our litigious society, part of me seriously doubts it, but I’ll keep my fingers crossed anyway. Go RCM! We’re rooting for you.

The word goes something like this: About five years ago, I was broke (notice how much has changed in the intervening five years!). I had recently befriended a woman who lived in my neighborhood, and one evening, while hanging out at her house, I noticed that she had a bunch of terry cloth pads laid out next to her sewing machine, made from a cut-up bath towel. When I asked her what they were for, she introduced me to the concept of alternative, reuseable menstrual gear. I was, to put it mildly, a bit flabbergasted. Keep in mind, I was a good girl from the midwest, who’d only been living in New York City for two years at that point, and still hadn’t fully lost my shy, midwestern ways. The message that our society sadly pounds into the skulls of young women (myself included) is that your period is dirty, something that needs to be kept secret and “sanitary”, and most definitely hidden from others. As girls, we’re taught that menstruation is an unfortunate part of growing up, a curse, or at the very least, a major, monthly pain in the ass—something that needs to be tolerated and dealt with, but rarely something that should be celebrated and enjoyed. As part of our induction into womanhood, we’re inundated with ads from the feminine “hygiene” industry, promoting the benefits of this product over that, and encouring the idea that the selection of a feminine hygiene brand is an important rite of passage. All of this just compounds the sense of shame and embarrassment that so many of us feel about our bodies—magazines are full of ways for us to “fix” our bodies, lose weight and attract the man of our dreams by wearing the right clothes and smelling the right way. Commercials for pads and tampons rave about how fresh, clean and discrete their products are. Douches urge us to “cleanse” our (naturally dirty?) vaginas so that they’re strawberry-scented or flower-fresh (and cause untold infections in the process through drastic vaginal flora disruption).

The feminine hygiene industry is a billion dollar industry that feeds off of women’s insecurities and doubts, and has us all suckered into the idea that spending $200 on menstrual products a year is just an unavoidable part of being a woman. Let me put it this way: do you think men would spend $200 a year on hygiene products if they too had an unavoidable monthly biological process that was part of their healthy life-cycle? I’m guessing not. If men had menstrual cycles, I bet health insurance companies would have started covering the expense of their supplies long ago, since, after all, these products would be essential to the health of the insured, same way insurance companies will pay for prenatal vitamins, or the needles and glucometers of diabetics. Why should women be expected to pay out-of-pocket for something that’s part of their yearly health and wellness? (This is somewhat similar to the “logic” used when health insurance companies will pay for viagra, but refuse to cover birth control…but that’s a rant I’ll save for another day). Women have been using cloth for centuries. It’s only very recently that we’ve been expected to pay every month for the pleasure of bleeding onto pearly white, cotton pads.

One woman, in her lifetime, will go through close to 11,000 pads or tampons. That’s a huge amount of uneeded waste going straight to the landfill. The women on this earth account for 51% of the population. If all of us use 11,000 pads in our lifetimes…that’s gotta be a landfill the size of Australia! It’s worth switching to re-useable products for that reason alone, but wait, there’s more: disposable pads suck! Not only do they take up way too much space, and get tossed out after only a few hours of use, but the packaging that comes with the products (the boxes and applicators) are also nothing but landfill fodder, and often end up washing up on beaches. While the FDA assures us that tampon companies no longer use chlorine-bleaching processes to get those pure, snow-white results they’re looking for, this was a practice that was used for decades before the FDA recently outlawed it, and untold amounts of toxic dioxins have been released into our environment because of it, disrupting ecosystems and bioaccumulating in lakes and rivers. (The FDA was also very quick to dismiss the idea that the dioxins in tampons can cause TSS or possibly cancer, but even without the dioxins, tampons are still perfectly capable of causing TSS on their own, just by being such a lovely, squidgy vector for bacteria and infetion). Sadly, dioxin is a very persistent chemical, and even though companies now use chlorine-free bleaching processes, the damage has already been done. Our children and grandchildren will be drinking and eating trace amounts of dioxin in their water and food for decades to come, thanks to the toxic feminine hygiene industry. And I ask you this: why is it necessary that the cotton and rayon of pads and tampons be bleached in the first place? They’re not sterile products that are used for surgery or wounds; they don’t have to be bleached.

Anyway, to make a long story short, my initial reaction to my friend’s cotton pads was “eeewwww!!”, however, it didn’t take long for her arguments to make sense to me: 1) I was broke, and the idea of saving $200 a year not spending that money on pads was very appealing, and 2) I have always been trying to find ways to make my environmental footprint on this earth a little bit lighter, and using cloth pads seemed like a really simple thing to change, which actually has a very large cumulative impact. So I purchased a starter kit of reuseable cloth pads to take care of all my monthly needs and voila!, I was hooked. I’ll let others extol the virtues of free-bleeding, but for my own part, there was something deliciously empowering about taking this aspect of my life out of commercial, profit-driven hands, and into my own capable, human hands. There was also something immensely satisfying about blowing raspberries at the TV screen whenever an ad for tampons came on, and feeling smug and pleased with the knowledge that while other women spent money on pads every month, I didn’t! Course, this method required a certain non-squeamishness when it came to blood, and a willingness to wear heavy cloth pads in my underwear once a month (which did, I must admit, feel like I had a phone book between my legs every now and then), and of course I had to soak them and launder them appropriately. For about two years, this routine suited me just fine (and cloth pads are great, and continue to work well for millions of women around the world)…but then…THEN…I discovered the joys of the Keeper.

Believe me, once I was finally sold on the beauty and sustainability of cloth pads, I was a true-blue, born-again convert, however, I have found that I prefer the Keeper to cloth pads, which means that in my book, it’s really very VERY good. This little cup is a latex product that fits inside of your vagina and functions a lot like an OB tampon, collecting your menstrual flow without drying out your vaginal walls. It requires insertion with your fingers, and periodic emptying (your collected flow can be conveniently emptied into the toilet, then the Keeper can be wiped off and reinserted); I must admit, it does take a little bit of effort to learn how to get it in and out, but once you master it, this is by far the easiest form of menstrual protection I have ever used, AND it’s ecologically friendly, sustainable, reuseable, and relatively cheap, given that you only have to buy one, and then you’re set for the next 10 years. Another beauty of using a menstrual cup is the fact that you don’t have to change your cup nearly as often as you have to change a tampon. On light days, towards the end of my bleeding cycle, I can happily put my Keeper in during my morning shower, and leave it in all day, and forget that it’s even there. And then, at the end of your cycle, all you have to do is wash it out with antibacterial soap, let it soak overnight in a bowl of water mixed with a tablespoon of hydrogen peroxide, white vinegar or tea tree oil, and that’s it. So, for those of you who like functionality of tampons (and the lack of phone-book-between-your-legs), but would also like to stop feeding the fat purse of the toxic feminine hygiene industry, and do our planet a major favor, a menstrual cup is definitely the way to go. The Mooncup and Divacup are also every bit as fantastic as the Keeper, they’re just made out of silicone instead of latex, so for those of you with latex allergies, rest assured, there are menstrual cups out there for you, too!

That’s pretty much the end of my schpiel. I know that what works for some women certainly won’t work for all women, but I urge you to think about your menstrual choices. Once you start using alternative methods, you begin to wonder why you ever needed a 7th-grade introduction to feminine hygiene products in the first place. I started using alternative methods about five years ago, and I haven’t once looked back.

For further reading:

The Wise Wound by Shuttle, Redgrove & Drabble.

The Woman in the Body by Emily Martin.

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.