Tuesday, October 16, 2012

Don't hate me, I'm pro-choice ... and pro-life....

(Foreward: --- aka warning --- this post deals with a controversial topic... it's my personal opinion, and I beg you to read it and recognize that I understand and respect all the very personal, intimate feelings about this. There are multiple ethical, moral, and religious aspects, and I grasp the enormity of even acknowledging another perspective - much less trying to be "okay" with one that defies your own personal beliefs. That said....)

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Dear friends...

I love you all. I love your babies, the smooth chubby cheeks, the gurgly giggles and the snuffly coos as they snuggle into a chest for a nap. I ache with you when you share the sorrow of your losses - the babies born still, the grandchildren suffering unfair illness and the sisters desperately hoping for their own babes. My own uterus skips a beat with each sweet, slick gift of life passed from a mother's womb to her arms; there's not a thing I would not do or give to see a smile cross the face of my own Littles, and the thought of seeing them in pain causes an almost physical pain to take seed somewhere deep inside my soul.

Abortion.  (I said it --- I think I had to, right? We all knew it was coming, eventually...)  I can't imagine being in the situation of having to weigh the decision myself --- to continue a pregnancy or potentially terminate... and am thankful I have never found myself in that situation. Simply remembering the bungee-cord of emotions that were rampant with both of my pregnancies - enhanced by a history of depression - leads me to feel that much more pain for the burden of fear and anxiety placed upon the hearts of any woman led to consider termination. I was a married, employed, educated woman with a planned pregnancy and resources up the wazoo (and the knowledge to identify countless more), and still scared witless; to a woman (or young girl) without reliable employment or education, a supportive partner or family, limited or any resources, who becomes pregnant, the future may be terrifying.  

This post is not meant to be a religious rant, a political push, a vicious argument against the ardent "pro-life" community. I believe in life.  I'm as pro-life as I am pro-choice. I believe in a G*d, some Creator of us all, a balance of all that is right/wrong, happy/sad.  Life begins, when life begins. To split hairs and debate the moment of "life" versus living cell seems frivolous, when to the women whose wombs carry those cells are in turmoil.  

I care for women, for families, and for babies - all of these groups, none of them exclusively of the other. I will not, as a healthcare provider, perform elective terminations ("abortions") --- but I will counsel my clients on all available pregnancy options, and never judge them for the decisions that they make.  I do not believe I could ever choose to willingly terminate a pregnancy which has taken hold in my uterus... but unlike too many of the women I've met, I've never been gang-raped, never been homeless, never been to the point of opening the door and finding social services peering in the corners looking for evidence of drug use and threatening to take my babies away.  The hardest financial "struggles" I've faced have been wondering if I would be able to make my cell phone payment and cable bill on time, or if deferring my student loan payments would be necessary... our family hasn't sought emergency food assistance, or faced cold winter nights without electricity.

When I close my eyes, and drift into dreams, I imagine a world where every strong "pro-life" family takes in a family coping with an unintended pregnancy (literally or figuratively), providing shelter, support, understanding, hope --- a home for a baby, ultimately, if needed.  (Of course this is in a land of lolly-pop trees and cotton-candy clouds... the logistics are nutty and no one's house would actually be large enough to accommodate an extra family - but work with me people!) To be serious, the crux of the matter - at least from the limited viewpoint that I've dealt with it - truly is the lack of support and resources generally available to women who find themselves immersed in unplanned pregnancies. 

Resources, education, support... oh my!  I dream, too, of a day when access to contraceptive options (including emergency contraception and preventative care/medical visits to discuss and explore different options) is readily available - without judgement, prohibitive cost, or excessive delay - to all women, with coverage from all providers. My faith is that I need to care for the women and families that I see, giving compassionate, holistic care; for some women, this will be supporting them as they continue pregnancies they weren't prepared for. For others, this will be counseling regarding termination. For all, it will include reliable contraception counseling talks, discussion of support services, and continued communication for months after our initial encounter. Though it is not up to me to weigh the life of the baby-to-be against the mother and family's emotional/financial/physical health and well-being, I have a strong faith that the G*d I trust in will deliver peace to the souls of every life involved...

Please open your heart and mind to those who hurt... be blessed...

Monday, October 15, 2012

THAT midwife... (Or, let's just be honest, eh?)

You know. THAT midwife - the kind that schedules elective inductions, has short prenatal visits, tells laboring women, "if we break your water, it may help speed this process up a bit." {{shudder}} I disdain that midwife --- or doctor, or whoever --- and rolled my eyes at her throughout my training. No way would I disrespect my clients or gamble with their health and well-being.


I might as well get it tattoo'ed right across my cheekbones. It's me!! I'm her! I'm THAT midwife! *sob* I realized last week how blurred the line has become for me; of the babes I've caught since I've come here, only half (give or take) have been spontaneous labor. The ones that have been induced have rarely been for good, solid medical reasons. Epidurals run rampant - and I don't talk mamas out of them. Initial prenatal visits include a pre-canned speech including reassurance that choosing a CNM-assisted birth does not automatically rule out pain medication or epidurals; women whose eyes widen at the thought of going into spontaneous labor on one of the six days in a given month when my partner or I are not on-call are quickly comforted with a subtle promise, "depending on how you're doing and how favorable your cervix is..."

Who have I become?!

Part of me bristles at this recognition. I don't want to be a "medwife". For every 5-10 minute, tummy check/dopple/how-ya-feeling? prenatal visit, there are four times as many that last three times as long (not to mention the "well" woman visits, gyne exams, and primary care...) As a general rule, our patient population needs *midwives* , not medwives; so many of our families are wrapped in generations of epidemic substance use, alcoholism, violence, and broken families. To be "with woman" consistently - providing unbiased, compassionate care for months and years without fail - seems like the best gift to offer these women, both those who seem to be desperately seeking it and those who push it away. On the other hand, to balance this, time gets away... the "good" patients get quick visits... and unfortunately sometimes things get missed. (I know that this has to happen --- the quiet, sad-eyed primip? During a brief, mid-pregnancy visit when I'm focused on the drug-addicted mama I had just seen --- or worrying about the postterm multip who had again been a no-show --- I might miss the cues that she's giving that something is wrong. I might not ask the right questions, give her the time she needs to feel comfortable to open up to me. Shit.)

But - the realistic part of me knows that some of this had to happen. Inductions happen; so do epidurals, and so --- knock on wood --- will c-sections. Without generalizing the women I am so blessed to work with --- I don't practice in a population that will (can?) embrace the granola-crunchy, no-interventions-please philosophy. (Happily, they don't generally fit the "yes sir, whatever you say, Doctor" mold either... these mamas are strong, and will do whatever they know is best in their situation).

My hope is that I can continue to cultivate growing relationships with each woman and family I work alongside, as well as the community itself, to find the "right" plan for her situation. No glibly tossing out the "I" word, giddily skipping down the L&D hallway to pop a bag o' water, or passing out epidural tubing and meds like candy at a 4th of July parade - simply trusting the relationships and our communication to find the path to a healthy, happy end.