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

- Last week at school I had a study day that covered pharmaceuticals in pregnancy (nothing I didn’t already know, thankyouverymuch to reading a lot about it, and having a Bachelor of Science and Bacherlor of Technology!), ultrasound (didn’t change my mind about it, did get me thinking more about it but generally frustrating in the way that many of the fellow students believed everything that was said), quit smoking campaigns (important message but really, what smoker thinks that smoking is safe and healthy and smart, and what woman isn’t adult enough to work out herself that it’s not a fabulous idea to do when pregnant?) and then a CTG workshop which was really interesting and I loved that feeling of "more more more fill my brain up" that I get with truly learning.

- Scary scary new device on the market: The underlying concept behind BirthTrack is the use of ultrasound technology to calculate the distance between sensors. BirthTrack system monitors cervical dilatation by transmitting ultrasonic waves from transducers (placed on the abdomen) to receivers affixed safely and painlessly to the mother’s cervix. Thus cervical dilatation is monitored continuously and automatically with a high degree of accuracy, reducing the need for manual examinations.

- New ticker to count down until I finish school.

Registration will come in 2010 so I’m not thinking that far ahead at this point. Plans post-uni are a little up in the air at the moment. I have the chance to work as an assistant in midwifery next year and I’m considering doing that instead of working in retail still. When I register, I have to do "something" to pay the bills, so I’m thinking either going the New Zealand for a year or more experience (woo logistics of all that!) or else working somewhere in a graduate position for a while. Do I have to make these decisions now - yes, and no. I have to make some plans in the next few months I guess (must update the resume in preparation for this!) to be able to step into 3rd year with confidence.

- Hopefully I’ll have some more babies in the next few weeks. I’m missing out on the babies and the new mothers and fathers thing at the moment. I attended a c-section recently and that’s about it - and not a lot of midwifery that I could do as it was at a small private hospital that I’d not worked at before so I did the "with woman" thing incredibly well and babbled about things that came to mind.

*sigh*

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.

I’ve been wondering about a few things recently.

• The purple line and its relation to dilation - meaning that lots of VEs were done on women as they progressed through labour to see whether there was a correlation. 
• Why we wait until 10cm to be convinced that a woman is dilated.
• Where the 10cm rule came from.

"There is a rule of labor that forbids a woman to push with contractions until her cervix is completely dilated to 10 cm. Women are warned that to push before this doorway is completely open and out of the way will result in a swollen and/or torn cervix."

I’m curious to hear more on this topic and when I’m done with my current paper, I’ll look into it some more.

I’m developing a style of practice that is being hands off and observational, which is often in conflict with the hospital system that I am learning in. I get that I am a student and that I have to learn before I can be. I also get that I am the midwife I will be in the future; it’s in the heart and soul, not in the textbooks, but I need the knowledge and skills to catch up to that passion. But wow it’s hard going to be trained in The System when I don’t agree with so much of what I have to do.