You Can Lead A Horse To Water...

You may have noticed that whenever you have a health care encounter- an office visit, your gyn exam, an emergency room visit, when you birth in a hospital- you are asked if you are safe in your relationship. This is typically asked by your nurse, and (hopefully) asked in private. It has become a standard question on the admission process in hospitals, regardless of your age or gender or why you are there, and even at your primary care doctor's office.

This is a good thing- it can help those who may be in a bad situation. The unfortunate thing about asking about abuse and domestic relationship issues is that many do not disclose this information. It may be because the person doesn't want to, or doesn't believe they are a "victim" of domestic abuse, or because they are afraid to. I remember going to a conference on domestic abuse in the health care setting and hearing that it takes a women seven encounters by the same health care professional before she will disclose her domestic abuse situation. That may never happen for many women- except for the prenatal care setting. Where else does a woman consistently see her health care provider so frequently in such a short period of time?

I work with a nurse, Kerry, who is one of those women. But she is one of those who doesn't realize that she is in an abusive relationship. She comes to work, many times visibly upset or distracted, taking 20 phone calls before the shift is half over from her husband, who calls to check on her. She makes numerous calls to him, as well, where you can hear her making excuses for her "behavior" or apologizing for whatever angered him most recently. Kerry talks about how he controls her money, her friends, and her contact with family. Her husband even checks on her computer history everyday to see what websites she is on, and must keep her passwords to accounts open to him.

Kerry has for years talked about how much she hates all this. But yet she doesn't see it as abuse. And she so desperately wanted a child. She even said, to every one's surprise, that she thought a child would help her husband be a better person and would love her more.

Kerry's husband did not want to have a child, but she did become pregnant. She recently gave birth to her son, and chose a doctor that we work with. Kerry was now one of our patients, and the admission nurse asked the requisite question about domestic abuse. Of course, Kerry poo-pooed this question, saying something along the lines of, "Oh, no, never!"

And so what do you do? This situation is different than most, as most of the nursing staff knows Kerry well and has heard and seen all sorts of things that point to an abusive relationship. No one did anything more than ask the question; and I can't think of what else could be done. I have been witness to, as well as part of, conversations at various points in the past few years with Kerry where she has been confronted with the nursing staff's suspicion's and concerns. Kerry never admitted to being in an abusive marriage, but would often cry- something that made me believe that she knew something wasn't right. Another nurse set her up with a therapist, another gave her a book about women in abusive relationships. She accepted these things, but never followed through.

If Kerry was a minor or a senior, this abuse would have to be reported to the police for investigation. But with an adult women, all you can do is lead her to the available help. It's up to her if she is ready and willing to accept it. This is so frustrating, especially when it's one of your own.

VBACs- Where to get 'em

Want to know if you area hospital "bans" VBAC? Here is an awesome list from ICAN. Also poke around their site for more info on VBAC and the ridiculous things that hospital talking heads say why VBAC is "banned".

You can also submit info about VBACs at your hospital to ICAN, or if they missed one you can tell them.

Nakedness

So another nurse I work with started discussing how a woman she was caring for insisted on being naked throughout her labor, and even after when she first got up to go to the bathroom after she gave birth. The nurse was bothered about "where to put her hands", and that this woman seemed to have a complete lack of modesty.

I argued why not be naked? Who cares? And why exactly do your hands have to be on some part of her? I mean, if the woman was steady on her feet enough to get up and go to the bathroom, you only need to stand next to her as a just in case she decides to go down. Not to mention that many women feel encumbered by all the stuff we attach them to when the come to the hospital. I know that I would probably be annoyed by having belts strapped around my abdomen, being tethered to an IV pole, and given a johnny to wear that has scratchy, starched ties that continuously rub the back of my neck.

Also, it wasn't like this woman was walking the halls naked, alarming some of the other visitors and patients.

And on point of modesty, that gets left at the unit entrance when a woman comes into the hospital. If a woman is comfortable enough to be naked, then so be it. We expect that women just open their legs at our convenience when they are in labor (I'm not condoning this but I've seen so many providers with this expectation), so I don't get why all of a sudden the expectation is that women need to be covered up to not possible offend the staff.

Bottom line: who cares.

I mean, it's must preferred over seeing some random woman in the gym locker room who is just from the shower, bent over completely naked while she dries in between her toes. Because, to me, that is bothersome.

Homesick

Ya know, as much as I bitch and complain, and how much I hate that where I work as a labor nurse is close minded to midwifery (well, the docs, for the most part), I will really miss working there. There is something about the place that feels right. It feels like home away from home. Disaster could strike, a major emergency, anything and everything bad to the nth degree...it feels ok no matter what. When I go to work I like being there with my fellow labor nurses. Even the night shifts.

As time passes, and I still don't have a job as a CNM, I wonder how well the transition will go. Will a new place feel like home? And when I say home, I don't mean like a place I'd want to live, but a place that I feel comfortable in. Will I like the nurses?

Sigh....

That and I am very petrified of suturing perineums after having such a break from the last time I did them....

Read This

Thought I would share this editoral, found in a recent issue of JOGGN- the obstetrical & women's health nursing journal. I don' t think it states anything that people who read my blog would be surprised to learn, but keeps the discussion going.

Have It Your Way

I think there is a common misconception about midwives and epidurals or IV medications during labor. I think many people believe that midwives want (and perhaps force upon) women to go completely unmedicated and stay away from epidurals. Or that women who go to midwives have to go unmedicated. Neither is true in most cases. Of all the midwives I've met or worked with, I can't think of anyone as an "unmedicated birth pusher". I even had one preceptor who said that after she had her own children she suddenly couldn't understand women who wouldn't be open to pain relief.

I personally feel that a great birth is what the woman wants. Some women want the traditional midwife birth- unmedicated, no epidural- and they are very happy with that. Others are open to how things go- and either get an epidural, or use IV medications- and are very glad they did that to help them. And others want an epidural right away- and are very happy with their birth when they get to have an epidural. Should I tell them that what they want is wrong because of what I believe? No.

But I do want one thing: please be educated about your options.

It does bother me that women don't take any childbirth classes or read any books because their sister, friend, mother, etc, said just get the epidural because birth is not possible without one. They come in thinking the epidural will be immediate and are unaware that there are risks involved with the procedure. They are completely ignorant to other methods of laboring, like use of a jacuzzi, or being out of bed, or even a birth ball.

On the other hand, it has happened that a woman comes in saying quite defiantly that she wants an unmedicated birth, has done a lot of prep during her pregnancy to be ready for an unmedicated birth who then ends up begging for medication or an epidural during her labor. Perhaps this is where some take it that midwives push unmedicated birth on women, because most will discuss her original wishes with her, suggest another measure like a new position, a massage, the jacuzzi, you name it, before you go on to medication. Because you know that this woman has worked so hard towards an unmedicated birth, you want to help protect that for her, and perhaps using something else can help her get over the sudden panic that she needs medication or an epidural. But if she is still asking after she tries something else, then so be it.

I think most midwives are totally fine with whatever women want for their births when it comes to pain control. I know I am. I just want women to be educated about what their options are and not just taking an epidural or medication because someone said they should or couldn't birth without it.