Midwifery is catching

Perky’apostrophe is running a fundraiser for Medical Students for Choice and I’d encourage you to consider donating, and maybe win a prize as well as providing education for the doctors of the future in the United States.

When I come back from San Francisco, I’ll be running a week-long fundraiser and I’d like you to be part of it.  No, I’m not raising money for myself to buy a house or a new appliance.  I’ll be raising money to create better physicians.

After Roe v. Wade, hospitals stopped seeing a lot of injuries and deaths from illegal abortions and eventually most hospitals stopped performing them.  As a result of this, as well as political pressure and fear of being targeted by anti-choice whackadoodles, many medical schools quietly removed abortion from their curriculum.  Today your average first or second year medical student is lucky to get even a mention of abortion in a Pharmacology lecture, and it’s really rare for a third or fourth year student to see an abortion or abortion-related complication during the clinical part of their education.  Even OB/GYN residents aren’t guaranteed education around abortion - only 50% of residency programs have an opt-out abortion rotation.  I don’t particularly think it matters how one feels about abortion and whether it should be legal or illegal…I think we should want our doctors to be well-trained enough to deal with something that impacts over one-third of their female patients.  Even if the doctor chooses not to perform abortions, don’t you think doctors should know something about it?

Look, 87% of U.S. counties lack an abortion provider and the pool of trained physicians willing to provide services continues to shrink (the statistics for Canada are no less depressing).  Legalized abortion is under threat in this country, but the shrinking pool of providers threatens to make the legality issue irrelevant.  And maybe you don’t care, maybe you’re thinking, “Good! We shouldn’t make it easy for women to find abortion services!” Well, consider this: most medical schools devote more class time to learning about Viagra than to all forms of contraception combined.  Many medical students aren’t learning much at all about important things like sterilization procedures or pregnancy options counseling.  You wonder why we keep hearing things about gynecologists refusing to prescribe birth control pills and perform vasectomies on unmarried men.  And put into this context, the proposed Dept. of Health and Human Services regulations that would make it a federally-protected act to not just withhold information to patients on abortion and contraception, but provide false information, well…it’s frightening.

And so I’ll be running a fundraising drive to make better doctors.  And there will be prizes!!!  For every each $10 donated, your name will go in a drawing to win one of the following:

    * one pair of handmade socks
    * one half pint of handmade watermelon rind relish
    * one half pint of handmade peach butter
    * one half pint of handmade plum barbecue sauce
    * one half pint of handmade watermelon barbecue sauce
    * one pint of handmade tomato-red wine sauce
    * One handknit stuffed uterus
    * One dozen of the most fantastic cookies you’ll ever eat: chocolate chip with sea salt.
    * Two skeins of handspun yarn
    * Gorgeous agate earrings donated by Designs by Galina

What an exciting day for maternity care in Australia! We stand on the threshold of change and the possibilities are endless.

Hang on - haven’t we been here before? Why do I get a sense of de ja vu? Well, we have had a large number of these in the past with no change whatsoever, so I’m not holding my breath.

Details and ways to make submisions are here on the Department of Health and Ageing’s website. Submissions close end of October, with the review to be released next year.

What I’m worried about is that it will become a turf war between doctors and midwives, between doctors and hospitals and midwives, between women and insurers and generally everyone who has something to say about it. We don’t need a turf war - that’s already been had, and the women lost (I’ll leave debates as to who won up to other people, because I don’t actually care beyond that one statement).

There is a need for reform because women only get choice and continuity of care and carer when they pay for it out of pocket, and even then it’s sometimes a figment of someone else’s imagination that continuity is what they get… but when women will settle for their ob being there for 15 minutes for the arrival bit of their birth, or the 1/2 hour it takes to do a c-section, thinking that that’s good service because they know who he is, then there is something screwy with the system. Same with settling for having a complete stranger of a midwife because yours has "timed out" for that day or week.

The focus needs to be on what women want and need. This is a spectrum of things, from "unassisted birth with an easy path to registering their child" through midwife-attended or -assisted homebirths, into small hospitals, through to tertiary hospitals and then out  the other side into private hospitals and private obstetricians. To name just a few of the options.

I’d like to see something like New Zealand has, where the money follows the woman around. This could mean that obstetricians earn less and midwives earn more. It could mean that homebirth numbers rise because it is a SAFE option for birth, and possibly the safest but not the most socially acceptable still (I’m working on that). It should mean that more women have the chance to get to know their caregivers, and have them attend their birth, if that’s what they want. Lots of women don’t know anything different from the fragmented care system that exists and is delivered to the masses. Education as to their options, beyond this, need to be supported by the money.

Women can want all they like in the direction of a private midwife and a homebirth, but when their private obstetrician and a 6 day stay in hospital is "free" under private health insurance and Medicare, and a private midwife and homebirth is $3000+, and a public hospital birth is free, it can be a hard decision to make. Families make the decision to homebirth regardless of the cost only when they see the benefits and for a lot of people, there aren’t any because they can’t see them (fish, water, same analogy…). Same with birthing with an epidural or not - some would say they’d never go to a dentist without anaesthetic and others would say it’s a huge interference in the natural order of things.

Way off track from saying - go forth and read and respond, for tomorrow or next year or next decade, it may be you or someone you love or someone you know who’s making these choices.

That’s my GPA at the moment in fact. I am fabulous at some types of university essay type work.

In other news, when midwifery is hard, it is really hard. Today was a hard day. Yesterday was exciting and challenging (emergency c-section with classical incision, which was the first I’ve seen!) but today was just awful and amazing all at the same time. I can’t go into specifics but when there are two extremes of life - awesomeness and awfulness all at once - it wrings you out, chews you up and rips shreds off your soul. And in a professional sense you have to keep your shit together while inside you want to throw up, throw something, or throw your arms around the nearest person.

I realised the other day that the picture on this here blog is a little old. It was taken in the kitchen of the house before last, and it was when I was cramming for exams last year (winter) so a year ago? Wow. I have to work out how to change the profile pics but this is me now:

The first one was at 1am in the morning, the second in BRIGHT sunshine, the third is with killer red lipstick on so I wasn’t smiley and the last was the last time I had it professionally blow dried (Feb this year) so no, it’s not like that often! My hair’s gone quite curly as it’s gotten longer and dark red-brown with a few silvers in it, which cracks me up as my hairdresser insists that she discuss colouring my hair every time I go. Which is 3 times a year or so.

And yes - orange is my favourite colour at the moment. 

I’m on placement at the moment, after exams. That’s the reason I’ve not posted in too long - did you miss me? I have some things queued up to post about and have things to say so should get back into it.

In the past few weeks, I’ve attended a birth with a woman whom I worked hard with the get out from under obstetrician care and into midwifery care. She had been triaged into the high risk but hated the fact that the obs run an hour late for apppointments, don’t know her from a bar of soap, don’t do anything more exciting or high tech than the same palpation, blood pressure and fetal heart that a midwife does and generally had little empathy for her or interest in her specifically. The midwives at least have that. The last appointment with the consultant was about as personal as using an ATM and she looked at me afterwards and said "do I have to see him again?" and I said "no" so she stuck her head back in the room and asked for a note so she could book back into the midwives clinic and the ob agreed! He was a little shocked but signed off before thinking it through.

And yes, even as I type this, I’m wondering why women let themselves be triaged like that. This woman has one factor that put her in the high risk category and that one issue was never discussed with her or raised as an issue for her pregnancy and just never factored in her care… and yet it meant she was denied women-centred care.

Anyway, where was I. Right. A birth. I attended a birth and it was the first one in months that I’d attended and it felt good. It wasn’t a brilliant, change my-life-kind of birth - it was in fact quite average. But I was a good midwife and even in the context of a hospital birth it was great for the woman. She became a mother, just as I’m becoming a midwife.

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I recently asked the universe to help me with my follow throughs because I’ve been in a funk recently with seeking them out. I have to work up the nerve to talk to strangers and ask them to be a part of their pregnancy and births. It’s a really hard slog to do it and when you’re in a bit of a blue it’s even harder to do. So I asked the universe to help me out and I also asked my friends to help me out and I was, in quick succession, called by a midwife whose list I’d made it to the top of, called by a community midwifery service whose list I’d also made it to the top of, and then by a coordinating midwife who gave me two other leads. And all four of them said yes! And another follow-through whom I’d not heard from in a while got back in contact with me, so my heart rested a little easier. Chasing numbers is an awful part of my degree, you know?

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In other news, I’ve unenrolled from university internally and have gone externally for a couple of reasons. The first is that I need to work to support myself and my lovely fiancee and kitty, and working around uni is far too hard. The other is I get very little out of studying internally so I may as well put my time to good use, right? Uni this past semester has been pointless in a lot of ways. The classes haven’t added to my knowledge other than to frustrate me about the state of education in this country and to remind me that I don’t learn well in a classroom. 

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Osk and I have decided to make a formal thing with our relationship. You know, because a joint lease, joint car, joint $$ and living together wasn’t official enough. So a few weeks ago (date tba but that’d require me to look it up) I asked him to do me the honour of my calling him my husband. We have rings and will make it legal and official sometime next year but you may be picking up a vibe here of understatement. Neither of us is making a big deal of it and there won’t be a huge party for the engagement. Zaria (kitty) will accept any gifts on our behalf if you’d like to send us something - please give her a call to arrange delivery. There will be a party after our planned elopement to somewhere like Lake Ohau and details will come early enough for peeps to travel to Adelaide. Every question about wedding dates sets it back by a week by the way .