Friday, July 31, 2009

Playing Doctor

Sometimes, I get the feeling that many, if not most, of us in the health care field went into our lines of work because we simply don't like being the patient in a health care situation. We'd rather be the people who are in charge, the ones who know what's going on. Maybe I'm projecting, but as kids how many of us wanted to be the patient when we played doctor? I sure didn't. I wanted to be the doctor because being the patient held little appeal. The doctor got to use equipment and DO stuff. The patient just got to lay there and be sick. At no time during these play sessions did the patient question the doctor or get to participate in deducing what was wrong or deciding what to do about it. How did I (and so many others, I'm betting) learn these classic and faulty elements in the roles of doctor and patient at such a young age?

It must start when we are babies or very young children, for most of us. I remember my terrified little brother thrashing around on the table and eventually having to be restrained by four adults (he was 2 or 3 at the time) while the doctor looked into his infected ear with an otoscope. No one spoke to him or asked him what was wrong or why he was so afraid. Poor kid hasn't been to the doctor willingly since then. He's now 21. My own personal experiences with doctors as a child were often less than pleasant. One of my earliest memories is peeing in a doctor's lap as he gave me a shot in the buttocks. Hey, I told him to wait and he refused to listen to me! Note to pediatricians, when a 2 year old says, "Wait, I've gotta pee.", she may be stalling but maybe you shouldn't lay her across your lap in your newly carpeted office (instead of an exam room) and proceed to give her a shot! My dad was standing there unable to keep a straight face while I watched my urine soak the doc's pant leg. Even the doc laughed. I was mortified. Daddy apologized and dried my tears.

As an adult, the experiences don't get much better but by this time I made it a point to visit the doctor only if I was practically at death's door. When you have no insurance, that's an easy resolution to stick to. In 2007, I did have insurance. I also had a UTI that was morphing into some lovely kidney pain. After visiting the ER, I made an appointment with a nephrologist in my area. I was sitting in the exam room when the doctor came in to greet me. He glanced at my chart and said, "History of UTI, eh?". I nodded and he asked me to stand up. At this point, the doctor grabbed my crotch. Let me repeat. HE GRABBED MY CROTCH!!!!!! To add insult to injury, he said, with his hand still at my crotch, "Well, that's your problem right there. It's too hot in there." What the fucking hell??? I was stunned. My mouth simply hung open and no words came out. I did not punch him, though I should have. Nor did I push his hand away or yell any of the million things flying through my brain at that moment. I did nothing. I said nothing. Because he was the doctor. He was the DO-er and KNOW-er. He had the power. I was the patient. All I got to do was be sick. And after that, I was sick.

I don't hate doctors. Far from it. My dislike is for the unequal and counter-productive power dynamic that exists between many doctors and their patients. The existance of this dynamic isn't soley the fault of doctors or the medical community. I think that patients shoulder an equal share of responsibility here. But here's the problem. Most of us were patients before we were ever health care professionals and we've been socialized to be "good patients". A "good patient" doesn't ask too many questions, is compliant, and understands the patients' place in the medical hierarchy is below the doctor/nurse/midwife, etc. Today, we need less "good patients" and more people actively involved in their own health care. We need patient education and respect. We need to stop asking doctors to shoulder the burden of making health care choices for us because when things go wrong (as they sometimes do), whoever made the decision also carries the blame. We need doctors to stop practicing health care that's based on fear of litigation. We need to be the kind of patients who don't just lay there and be sick.

Tuesday, July 14, 2009

Religious Right? Or Wrong? Are We to Judge?

One night not that long ago, I happened to find myself involved in a familiar and uncomfortable conversation about religion and spirituality. Now, I don't usually delve into these conversations with perfect strangers due to the sensitive nature of the subjects. However, that night proved to be an exception. Funny, enough, the conversation did not begin in this vein. It was actually about childbirth, at first. See, I love to talk about birth and women's bodies and the political dynamics of both. I don't know how this conversation which was initially centered on the anatomy and physiology of the birth process ended up "in God's hands" literally and figuratively (mostly figuratively).
Before I continue, I feel I should clarify a few things about myself for anyone who is reading this. 1. I do believe in a power that is above and beyond my intellectual reach and physical understanding. 2. I do not generally identify with any particular religion even though I try to live my life according to values that some might argue are inherently Christian (though I've also been called a heathen and I'm totally fine with that). 3. I try my best to respect the views and beliefs of others, even when it's so much easier to write someone off as a fanatic.
So, back to the strange and uncomfortable conversation. The woman with whom I was talking had very stong opinions and wasn't afraid to share them with me. Several times during the course of the evening, she made references to "healings", "revivals", and "casting out evil spirits". This didn't bother me. I understood that she was Christian as were the 6 or 7 other women in the room. I continued my lecture on the stages of labor and birth. After my lecture had ended, she sought me out to talk and I was open at that point to discussion. I thought the discussion would remain in the realm of birth. Silly me. I should have anticipated otherwise. The conversation was fine until I was told that Catholicism, Traditional Chinese Medicine, Buddhism, etc. all contained elements of paganism and satan in their workings. This is when I started to get that sinking feeling in the pit of my stomach.
Seeing as how I'm neither Catholic, Buddhist, or a follower of Traditional Chinese Medicine, I fought to understand why I was feeling offended by her comments. Then it hit me. I don't like hypocrisy. I don't like when people stand behind the shield of Christianity (or any other religion that espouses love as a beacon to live by) and hurl rocks of judgement and condemnation at anyone who doesn't share their brand of faith. While I admire those who posses an unflappable faith in whatever it is that they believe, I admire humility and honesty more. I'd much rather discuss religion and spirituality with someone who says "This is what I believe with all my heart and I pray that it pleases God.", as opposed to someone who says, "This is what I believe with all my heart and I know that I'm absolutely right and anyone who doesn't believe as I do is wrong." Now, don't get me wrong. This woman seemed quite nice and I'm sure she never meant to offend me. She was simply stating her beliefs as she has a right to do and I didn't argue with her. After all, I was there in a purely professional capacity. However, I got the distinct feeling that even if I had chosen to share my view, at best, she would not have been open to hearing them. At worst, I might have been marked as a harbinger of evil, possibly satan's concubine, and condemned to the depths of hell. Oh, well. Maybe next time.

Monday, July 13, 2009

Wise Latina Woman

I've been watching the confirmation hearings of Judge Sonia Sotomayor and I'm frustrated and disgusted by the display of White, male privilege and fear that I'm seeing. It blows my mind that we've made such strides in this country with regard to overt racism, but at the same time, those gains seem to mean nothing when the reality of racism pervades our government so thouroughly. Much of the controversy surrounds a statement that she made in 2001 saying "I would hope that a wise, Latina woman with the richness of her experiences would more often than not reach a better conclusion than a White male who hasn't lived that life." Due to this statement, there is much talk of "reverse discrimination" and "reverse racism". Every time I hear these phrases coming out of the mouths of supposedly intelligent people, I want to scream. What the hell is reverse discrimination/racism???? As far as I know, racism is racism and discrimination is discrimination regardless of who is being discriminated against. No one race, gender, religion, etc. owns racism or discrimination. The belief that racism can only be perpetrated against people of color, for example, only serves to make racism okay (as long as its not publicly, and blatantly exhibited) because its something that only hurts "those people". The reality is that racism and discrimination hurts society as a whole.

What I don't understand is why this woman is being taken to task for asserting that her ethnic background and gender have an influence on the way she views the world and (gasp!) the way she may rule on cases. Is the same not true for the hundreds of White male law-makers? Am I to believe that White males' policies and judgements are not influenced by their upbringings, their race, and their gender? It's as if they would have the world believe that only people who are not White and male are suceptible to influences such as race, ethnicity, gender, and social class. Seriously????

I certainly understand Senator Lindsey Graham's assertion that if he had made a similar comment being that he is a Whilte male that he would have been condemned as a racist. However, I would argue that in the country in which we currently live, a White, male law-maker doesn't have to discuss or defend the influences that his gender or race have on his ability to make wise choices. He may discuss being a farmer or coming from "common" roots, but he doesn't dare publicly reflect on how White privilege has shaped his view of the world.
In American politics, White and male is the yard stick that is accepted as the norm. Everyone else is, well, everyone else. It's hard for me to hear law-makers claim that it's important to have diversity on the bench, but only as an effort to prove that racism, classism, and sexism have been eradicated from American politics. Not that we need diversity because different people bring different viewpoints that may add to the richness of dialogue and communication. Come on, folks. I think the American public is tired of the posturing, eloquent language, and "code words" (such as empathy) that serve to promote the kind of fear that only propagates racism, sexism, classism, and all the other -isms that we desparately need to overcome.

Thursday, July 9, 2009

A Midwife's Transition

During labor, transition is often the most challenging period of time for many women. This is a time when a woman generally has to dig deep to find strength for herself physically and emotionally. I've seen many women begin to doubt themselves during transition. That's when they start to cry out things like, "Come on, baby. Mommy can't do this for much longer." or "Time out. I wanna stop now and try again tomorrow." The urge to quit can be strong, but women usually come through it and birth their babies (often within minutes of calling for a time-out). It's a beautiful journey to watch and I always feel blessed to be a witness to it. Although I've never physically birthed a baby, I feel like I can relate to this type of struggle on an emotional level. Actually, I feel like I've been in transition for months now.

My transition has been manifesting on many levels and in various aspects of my life. It began when I graduated from midwifery school last year. A dear friend and midwifery classmate was battling cancer. My determination to get through my schooling was fuelled by the fact that she had become so ill that she couldn't continue her midwifery education. What right did I have to complain of being tired when she was dying? Watching my friend, the woman who was supposed to be my future business partner, gracefully slip out of this life...that was a tough and valuable lesson. Every time I look at her picture where she's smiling at a mother and her newborn, my heart aches to talk to her again.

The next phase of my transition came a few weeks after my friend's passing when I got married. I love my partner and I love being married. Like many couples transitioning from being single to being committed and living together, there have been challenges for us. It's been hard for me. Especially since I moved to another state a thousand miles away (literally) from my family and childhood home the day after the wedding to be with my partner while he finishes his education. If someone had told me a few years ago that I'd be living in a state where it's warm only 3 - 4 months of the year I would have laughed them out of the room. Leaving my home just wasn't part of my grand plan. But here I sit.

The latest part of my transition actually has to do with this move. Unfortunately, I have found myself in a place that is not very mother-friendly, baby-friendly, or midwifery-friendly. After talking to several midwives here, I'm beginning to realize that I may never be able to practice midwifery the way my heart and mind see fit if I stay here. The midwives here are too often bound to hospital policies and medical practices that are not evidence-based or even common-sense based. And this is, in part, due to their hospital-based training. However, there is the issue of the midwifery laws in this state. In short, they leave much to be desired. I'm becoming discouraged. A part of me is ready to call a time out. All I want to do is serve women and families. Why does that have to be so hard?

Sunday, July 5, 2009

Educational Diversity in the Midwifery World

The other day, I received some disturbing news in the mail. The letter was from the midwifery licensing board (of the state where I now live). It basically stated that my application for licensure was denied because I had not received "the right type" of midwifery training. I wasn't surprised. I did not receive the type of training nurse-midwives might get in this country. Nor did I attend a school that is accredited by the American College of Nurse Midwives. So, the midwifery board in my state says I cannot get licensed until I fulfill those two requirements.

It's not that I'm under-educated. I have a Bachelor's degree and underwent 3 years of a rigorous direct-entry midwifery program that prepared me quite well to attend to the needs of women and babies during pregnancy, labor, birth, and postpartum. I then passed the North American Registry of Midwives examination without much difficulty. My training was, in some ways, formal. We met for class at designated times, attended lectures, completed assignments, and had mandatory clinical hours to fulfill. But, in some ways, it was far from conventional. We were required to take on an overnight shift once a week for the entire three years. We had on-call days (and nights) 3 times a week our first year and 7 days a week by our senior year. If you were called to a birth, it didn't matter if you were at work or at a family function or across town, you were required to hustle your butt to the side of that laboring mama. There was no "clocking out" according to your shift. You left when the work was done. Period. Doing these things readied us for the realities of midwifery. Women don't go into labor when you want them to and babies aren't born according to our schedules or timetables. Continuity of care is important because the more familiar you are with a mom's (or baby's) norms, the sooner you can be alerted to a deviation from that norm and take the appropriate measures.

I don't regret taking the route I did to become a midwife. I had several options and purposefully chose this one. However, there are some who feel that there is only one "right" or "best" path into this profession. That is a very limited view. For many years, education was done on a one on one basis - knowledge passed from master to apprentice. This practice still goes on today all over the world. For many years, this was the only way to become a midwife and, for some, it still is. There are many routes one might take to enter this great profession and all of these routes should be respected. Just because someone does not receive knowledge in the traditional euro-centric fashion, doesn't mean that knowledge isn't just as powerful. As an educator (remember my Bachelor's degree?), I understand the need to verify learning according to a certain standard. As midwives, we are charged with the responsibility of caring for mothers and babies. There are certain standards that we should follow to ensure the safety of both. However, let those standards be measured by a non-biased exam of some sort. What we should not do is declare our chosen path to midwifery as the yardstick by which all other midwives are measured. We need to respect the many kinds of knowledge that exist and the various packages in comes in.

As for me, I'm most likely going to appeal the board's decision. If I wasn't a fighter, I wouldn't be a midwife.

Friday, July 3, 2009

Your Child-lessness Is Showing...

As a birth professional, I get asked one question repeatedly whenever I talk to expected parents. It never fails. We're discussing pregnancy, birth, and/or newborn care and mom, her partner, or maybe even a grandparent will undoubtedly ask me, "Do you have kids?" It's a question that always makes me inwardly cringe just a little. My answer thus far has always been an honest "No, I don't have any kids, yet." Then, I get the look. What's the look? Well, it generally involves a slight widening of the eyes or raising of eyebrows (sometimes, both) accompanied by an upward tilt of the chin and the dreaded "Oh". *sigh* It's a look that seems to say, "Oh, so you don't really know what you're talking about. You've never been there." Actually, one mom said exactly that to me. I suspect others (but not all) may have thought it, but didn't say it out loud. And I don't blame them.

When I was looking for my first ob/gyn (at the age of 17), I insisted on having a female practitioner. My rationale was basically that a man couldn't ever truly understand certain female things such as menstrual cramps, PMS, or breast tenderness. Now, that I'm finding myself on the recieving end of this same kind of rationalization, it kinda sucks. Don't get me wrong. I totally understand the feeling of wanting a provider who you feel can relate to what you're going through. But sometimes, I can't help but think that this kind of judgement is a bit unfair. After all, most people don't insist on going to a cardiologist who has had a few heart attacks of their own, right? As a midwife, I am experienced and educated in a way many people (even experienced parents) may not be. And, to be fair, most people I encounter don't seem to base their entire opinion of me or the care I give based on whether or not I have given birth. In truth, the discomfort I feel at being asked the question and recieving the look, can probably be largely attributed to my own perceptions.

It's just that sometimes it doesn't seem like its all in my head. The world of birth and parenting is a world full of judgement. Whether it's medicated or unmedicated, organic or non-organic, formula or breastmilk; judgement creeps up in many, often well-meaning, ways. And it sucks to feel like I have to explain myself to every well-meaning parent who asks, because a simple "no" often doesn't seem like enough. I've been asked, "So, when are you gonna have kids?" by parents who I've know for no more than an hour. What does one say to that? Saying, "Well, we've tried and tried, but we're dealing with some infertility issues at the moment.", seems to put a damper on the convo pretty quickly but that leads to a whole other kind of look. And that look is more cringe-worthy than the first one.