Favorites from this week

How can I describe the past week? Difficult. Many, many, many women reporting domestic violence and rape. A fellow midwife I had just met and was training calling me privileged, I assume in relation to my direct entry program, as I ignored the comment since we were halfway into a patient's room for her visit. Multiple hours of interpreting for a couple's fetal demise. Eight hours fighting for one of my personal patient's tubal ligation when she traveled from far away to birth at that hospital, since the Catholic hospitals closer to her home would not allow it, and ultimately not succeeding due to doctor politics with each other,  a sudden emergency, and then the dinging of 5:00 on a Friday night.Friday night ended with a wonderful evening watching a performance of The Vagina Monologues at a local seminary school, where one of my friends performed. Such a lived experience for my patients and indirectly myself this past week, that many things were difficult to hear. My friend performed, "I was there in the room." And she was amazing. And I remembered that each woman has a story like that, and I was a privileged witness to them all week, and hopefully to be a support, a help, a midwife. Thankful....What Prostitutes, Nurses, and Nannies Have in Common - Robin Hustle at JezebelEmotional labor, the connection between sex and emotion, the connection between intimacy and healthcare, and the struggle to do what we love and love what we do. "...Hochschild defines emotional labor as "the management of feeling to create a publicly observable facial and bodily display." This is distinguished from "emotion work," the private use of emotional self-manipulation, because emotional labor "is sold for a wage and therefore has exchange value." In emotional labor, a worker's emotion is the commodity. Bartenders, therapists, child care workers and the like trade in emotions, and put their own private feelings on the line in the process. Emotional labor, like all work, takes its own peculiar tolls. In the world of commodified caring, the greatest risk to professional longevity is burnout, the stultifying feeling of not being able to keep up with the emotional demands of the job...Much of the work nurses do depends on translating authoritative knowledge into therapeutic communication; because nursing education has to prepare students for their eventual board exam, it often focuses more on absorbing and applying a vast catalog of knowledge and technical skills than on how to feel and show empathy, how to do effective patient teaching, and how to take care of your own emotions along the way. Outside of the caring professions, empathy isn't usually something that needs to be taught; when it's a part of your labor, though, it's more vulnerable and complex. When we learned how to do bed baths in class, we'd gone through the minutiae of every step (clean the eye from inner to outer canthus-common NCLEX question!) until we reached perineal care; for that, we were instructed to watch an instructional video at home. Considering that our instructor displayed her own discomfort with the matter, it's reasonable that Angela and others would be particularly unprepared for that kind of patient care.After years of childcare and years of sex work, I'm at ease with recognizing that genitals are sometimes sexual but not always, and I'm not disturbed or embarrassed by anyone else's body or bodily functions. I'm also accustomed to working harder to put my clients at ease when they're uncomfortable or unwell. A nurse can't treat a patient for Body Image Disturbance—the experience of being afraid, upset by, or disconnected from your physical appearance when it's affected by changes in health status—if she's disturbed by a patient's missing limb or incontinence and unable to disguise her own discomfort..."...The Evolution of Mom Dancing (w/ Jimmy Fallon and Michelle Obama)Move it, y'all. ...A Healthy Baby Isn't All That Matters - Cristen at ImprovingBirthWord."...In the real world, of course, birth doesn’t follow a textbook pattern; there are complications and changes of plans and undesirable outcomes.  But even when these things happen, a woman can still be respected and supported.  We may not be able to control nature, but we can control how we treat women in labor and birth.  Even in the worst-case scenario (especially in the worst-case scenario!), there’s no excuse for anything less than the utmost respect for, deference to, and compassion towards the birthing woman as she is making her choices.Because what’s really telling about the “healthy baby” phrase is that, so often, it’s used to justify a disappointing, difficult, or traumatic birth experience.  It’s said to us by our providers, our friends, and our families as we’re reeling from the shock of what just happened: trying to wrap our heads around something that seemed to go unexpectedly out of control.  And, yes, we tell it to ourselves.So what’s the key to a new standard?  It’s us!  It’s the moms whose business drives the industry that gives us that care.  Many of us don’t realize it yet, but we are in the catbird seat.  Imagine what could happen if we, millions of moms and dads and our friends, really took hold of that power and wielded it..."...Your Pregnant Body - 20 Things They Don't Tell You - Pregnant ChickenI struggle with each and every one of these, discussing normal and encouraging empowerment in a changing body, especially with first-time pregnancies and most-especially with teenagers. Important facts to cover, but sometimes I just shake my head and try to empathize. "...Symptoms like fatigue, nausea, back and joint pain, constant peeing, constant hunger and being “emotional” (both good and bad) are all considered par for the course when it comes to pregnancy so no one is too surprised by them. However, there are many (many) more delights that can come along with a positive pregnancy test that people don't talk about or show you in the movies.Here are just 20 of the lesser known pregnancy side effects and symptoms to give you a bit of a heads up (or scare the crap out of you if you’re a teenager that wants to be on a reality show) so you know you're not alone.You may have all of them to which I can only say, “I’m sorry” and only assume that karma will reward you down the road because you hit a lottery of crap. Or you may have none, to which I say, “Lucky, whore” and seat you at the exquisite birth table that is currently occupied only by Gisele Bundchen – my patron saint of pregnancy (sorry, Saint Gerard Majella, you just don't cut it with me as a pregnancy saint because you're a virgin....and a man.)So sit right back and you’ll hear a tale, a tale of a faithful trip, that started in this uterus and quickly turned to shit. (Just kidding, but I love Gilligan’s Island)..."...How do good candidates for Trial of Labor After Cesarean (TOLAC) who undergo elective repeat cesarean differ from those who choose TOLAC? - Torri Mertz et al. in American Journal of Obstetrics and Gynecology, Feb 2013.Go midwives! 

"Abstract

OBJECTIVE:

Our aim was to compare good candidates for trial of labor after cesarean (TOLAC) who underwent repeat cesarean to those who chose TOLAC.

STUDY DESIGN:

Data for all deliveries at 14 regional hospitals over an 8-year period were reviewed. Women with a primary cesarean and 1 subsequent delivery in the dataset were included. The choice of elective repeat cesarean vs TOLAC was assessed in the first delivery following the primary cesarean. Women with ≥70% chance of successful vaginal birth after cesarean as calculated by a published nomogram were considered good candidates for TOLAC. Good candidates who chose an elective repeat cesarean were compared to those who chose TOLAC. Women who were delivered at 2 preselected tertiary centers by a general obstetrician-gynecologist practice were subanalyzed to determine whether there was an effect of physician group.

RESULTS:

In all, 5445 women had a primary cesarean and a subsequent delivery. A total of 3120 women were calculated to be good TOLAC candidates. Of this group, 925 (29.7%) chose TOLAC. Women managed by a family practitioner or who were obese were less likely to choose TOLAC while women who were managed by a midwife or had a prior vaginal delivery were more likely to choose TOLAC. At the 2 tertiary centers, 1 general obstetrician-gynecologist group had significantly more patients who chose TOLAC compared to the other obstetrician-gynecologist physician groups (P < .001), with 63% of their patients choosing TOLAC.

CONCLUSION:

Less than one third of the good candidates for TOLAC chose TOLAC. Managing provider influences this decision."...American Public Health Association (APHA) - Get Ready CampaignGo public health! "APHA's Get Ready campaign helps Americans Prepare themselves, their families and their communities for all disasters and hazards, including pandemic flu, infectious disease, natural disasters and other emergencies."