A Letter From A Doctor Who Sees the Light

I know that the internet childbirth world is all abuzz about the AMA's resolution to "outlaw" homebirth, so I wanted to share this link with you. I found it very uplifting, and hope that a reply is posted someplace.

Stretching For Damage Control? Think again.

My husband came up with a very good point about perineal manipulation during the pushing stage of labor. I was talking about how the doctors and residents, and even some nurses, can't seem to keep their hands out of a woman's vagina while she pushes. They stretch the tissues out, push posteriorly on the perineal muscles, and generally create a very swollen perineal and labial mess. I hate it. My own personal practice is very hands off and have had good results- only one second degree tear, and the rest were either intact, minor first degrees or "skidmarks" not requiring anything but time to heal.

So this is what he said, "Why don't we do that when we have to take a shit? You know, a big shit might come through your anus so maybe we should stretch it out a bit before we go just in case it could do damage." This was the cleaned up version.

Good point.... good point.

Something Worse Than P.O.

My most recent shift I actually was coughing and gagging at a smell worse than P.O. I was working postpartum again and was attending to my final rounds of catheter bag emptying and general patient upkeep when I entered my patient's room for the ump-teenth time. But this time there was something pretty ripe about the room. I had caught the woman and her boyfriend napping and tried my best to be quiet as I made some final assessments, changed an IV bag, and then empty her catheter bag.

I saved the catheter bag for last because the boyfriend had parked the recliner right next to the side of the bed the bag was hanging on. I was hoping that he'd notice that I was moving about the room and would move out of the way. But he didn't. He just stayed right in the chair. I figured there would be enough space for me to reach and grab the bag out from between the bed and his chair, which there was, but when I went to reach for the bag I had to bend towards his feet. And here was that ripe odor.

People, I have never smelled such horrid, wretched feet in my entire life. There may have been visible fumes, but I couldn't bear to linger long enough to find out for sure. I had to breathe as shallow as possible but I still ended up coughing. It took all my might to not end up gagging as I waited for the bag to empty into my urine container. How could they not be bothered by this? You can imagine how glad I was to not have to go back in that room...ever.

Postpartum Sucks

Well, people, I have said this before but I will say it again. I hate working postpartum. This is the official complaint.

My "summer break" (if you want to call it that) is being spent on 12 hour shifts at work so that I can try to fill the hole of a bank account before heading back to clinical. And each and every time I go to work I end up on postpartum! My most recent response when I saw that I was assigned to the postpartum floor was, "Oh, that's just great!" This was met with a bit of silence, followed by, "Ya, we know, we know..." but being per diem makes you the low nurse on the totem pole, even if you have more experience and even attend births as the official catcher of babies.

I've wanted to say, "You know, I am much better suited to the labor floor, people... I'm going to be a midwife, for crying out loud!" But I think that might come off not so nicely. Besides, I have pissed off a few people because I am unable to work any of the summer holidays and the powers that be have allowed me to not have to work a holiday. To be fair, because I knew that this was going to ruffle some feathers if word got out, I offered to work some particular night shifts. And anyone who knows me knows how I loathe night shifts. (And I said I was going to be a midwife?) But, get this....I was told I was not needed on those night shifts. I almost fell over because they are always short on nights. So... whatever.

A Book with a Four Letter Word

So I've been reading this book called Cunt: A Declaration of Independence by Inga Muscio. First off, don't read it on public transportation if there are stuffy suburban mother's with their kids near by. They don't like that, presumably because they think you might whip out porn or something.

I find the book amusing. I haven't read the entire thing yet, and perhaps I shouldn't make a full statement on what I think yet, but it is interesting to read her take on things. I think the book is meant to be a power-enhancing liberation for women. There are some things I totally agree with, and others I wonder where she was getting her info. Like emergency contraception causes abortion.

There was one point she makes early in the book, though, that I thought was right on. She talks about the cultural belief in this country (as well as many others) that women are unclean during their periods. The mere fact that we use something called "feminine hygiene" to contain our "dirty blood" speaks volumes to how we view such a normal physiological function. We need to change our thinking about this, she says, and I agree.

Take for instance, how we deal with menarche- a girl's first period. It's a secret event, one that is, for most, treated like something that must not be overly discussed and right from the beginning girls are taught how to be discreet about such event. For anyone who has read The Red Tent, you know how differently such an event is treated. And the author talks about some woman right here in America that celebrated her daughter's menarche with a party. Soon, other mothers in the neighborhood were doing the same. What a fabulous idea. I'd imagine this is much different than what most of us have experienced.

Take my first period, for instance. It was a horrifying experience at the time, but I can laugh at it now. I knew that I would be getting my period at some point; I'd had the requisite school nurse presentation on the topic and had read several books from my mother. I was actually highly anticipating the event, only because I thought there would be some magical happenings would be sprinkled upon me and I'd suddenly be blessed with some secretive knowledge only women knew. But in reality, I just found myself staring with fear at my underwear in a school bathroom stall. And then promptly tried to ignore what I saw, and said nothing the rest of the day. At the end of the day I ran off the school bus to my house, my brother trailing behind me. My mother knew something was up, and she asked what my problem was.

"I got my period!" I exclaimed, and fell into a pile of tears. If I remember correctly, my mother tried not to crack a smile. She said something to me about the practicalities of it, how I would just simply use a pad in my underwear. Note much else was said.

My brother, having come into the house in the middle of this, listened with interest. And then, when he felt he understood what the big deal was, he yelled out with glee, "[Labor Nurse] shit her pants!"

It was awful, but I write this while laughing.

But I wonder how different this experience, as well as most of yours, would have been if we didn't view this thing as unclean.

The Hidden Baby

I received this picture via email from someone at school, and it took me about 3 months to see the baby. I have never been able to see the hidden pictures in those magic eye posters years ago, so I guess it's no surprise that it took me as long as it did. I hope I am not the only one!

No Puke Zone

If there is one thing that I absolutely fear in my line of work, it's vomiting. Not vomiting while in labor, because most women in labor who puke have little in their bellies so it's not chunky, but vomiting from a virus. I absolutely dread such a thing.

When we get women in triage who need IV hydration for nausea and vomiting, I pray I do not get assigned to them. As soon as I hear that such a woman is going to be on our unit, my anxiety level shoots up ten-fold. Recently I've had a string of women at clinical who come in for this exact thing, and of course I am the one who assesses them and sits with them. I have to come in full contact with these women with the horrid viruses and I pray constantly that I do not catch what they have. I am a good hand sanitizer in general, but you can bet your last dollar that I am practically bathing in Cal-Stat and Purell before, during, and after caring for these women.

The reason for my fear and anxiety is that I am a horrible puker. I hate it more than most, I think, and even as an adult I cry. I try to bargain with the Gods and Goddesses to please just give me horrible diarrhea if I have to be sick- anything but vomiting! The mentality of just puking, getting it over with, and feeling better just doesn't jive with me. I would rather have hours of nausea and diarrhea than puke once. Frankly, I envy those who can puke like it's an aside. Like, ho-hum...I feel sick...let me puke....bluh.....ok, I'm done...what was I in the middle of saying?

This fear didn't start until I was a teenager, likely because I had had enough experience to know how much I hated it. I remember vividly one of the worst cases I had ever had: I was 22, and caught the most wretched bug that was striking people down left and right at work. It had been going through our patients (I worked with elderly at this time) and staff for a good month. I managed to stay away from just about anyone who came down with it. And then I realized that I was one of two nurses who had not become ill.

The same night I realized this, the other unaffected nurse called in sick. She was the only night shift RN, and there was no one to cover for her. So I said I would stay (oh, the days of pulling a double! I think I would die if I worked 3PM to 7AM now). Two days later, I found myself at home on New Years Eve after last minute cancellations. So I sat in front of the TV eating a pint of Ben & Jerry's Chocolate Chip Cookie Dough.

At 11PM, my stomach to feel queasy. I went to bed shortly after midnight, but my stomach felt even worse and I knew what was coming. By 1AM, I was hugging porcelain, and did so non-stop until 7AM. The following afternoon, when I finally started to feel a little better, my abs (I actually had some then) felt like I had put them through a Muscle Man competition.

So why do I tell you all this? Because I hate it so bad, that memories of that awful experience are so vivid, and because I had nothing else to write about. Oh, and it took me about 2 years to be able to eat Ben & Jerry's Chocolate Chip Cookie Dough again.

How is this possible?

You know, it really irritates me when my fellow students course work completely sucks but they get decent grades. We have been finishing up the semester and have several presentations to make. I put a lot of work into my presentations, spent hours just on research alone- making sure that I use current references from respected sources, assuring that typos and grammar is correct, and my APA format is perfect.

I have always done well on my presentations, having always received full credit (ya, I'm a dork, thank you very much) and have always believed I deserved such credit.

So when the crappy students are getting passing grades when there are blatant errors in their presentations, lack of APA format or current research and data- not to mention presentations that support the medical model of care (some one poke my eyes out, please!)- I am highly insulted. If I get an A on a presentation, and the person after me has a total blow out of information but gets a B+.... how is this possible? How can the instructors justify this?

Urgh....only integration to go.... I'm done in August!

A Board

I recently learned that the Commonwealth of Massachusetts has legislation underway that would create a Board of Midwifery. I had no idea that this was something that was in the state legislature, and was happy to hear about it. I have not done much research on it, but from what I understand this Board would regulate all midwives in the state. This includes CNMs, CMs, and CPMs. Currently, only CNMs can practice legally in the state. If this Board legislation goes through, which apparently has made it quite far and it is looking promising, then the creation of CM and CPM licensure would follow. This would allow for women in Massachusetts to "legally" choose the women's health provider of her choice.

As you can imagine, ACOG opposes this Board. They seem to be ok with CNMs practicing under the current nursing regulation as they provide "a valuable service to our (ie, the doc's) patients" but think CMs and CPMs are under qualified to "practice medicine". Which completely boggles my mind given the fact that all midwives, CNMs, CM, and CPMs, practice midwifery. In the Act put out by ACOG, there are some talking points for physicians in Massachusetts to discuss with their local representative. They state that CPMs, also known as lay midwives according to ACOG, only need to do 10 births as an apprentice. Is this true? Again, I have not researched this, but I had thought that CPM apprentices are required to attend 100 births or something like that. That is more than CNM and CM students are required for graduation as the ACNM only requires 20 births. I admit I am completely ignorant to the educational standards of CPMs so any information you can share with me is appreciated.

Regardless, I hope that this bill makes it to law. Establishing a board of midwifery in Massachusetts would open the door to more states doing the same. Perhaps midwives throughout this country could completely cut regulatory bureaucracy that restricts their practice....I hope to see this in my career.