Temptation

Posted by Tatiana

I'm in earshot of the siren call of the temptresses of number-bending.  Oh, the lure, the lure!  Not number bending, exactly, but we'll call it selective emphasis. I did a research project this fall about the experience of babies in labor and birth and it involved an online survey. I ended up with over 500 responses from all sorts of birth settings (I didn't only post it in natural birth cyber land, you know!) so I have this amazing spreadsheet of quantified experience. It makes me drool just thinking about it.

I can think of dozens of fascinating comparisons to make, and it's been a pleasure to get my hands dirty with collating data. I fully expected that all of that would the fruit of this experience, but I didn't anticipate that it would acquaint me with the temptation that I can now imagine faces many "real" researchers.  Sitting before a mound of numbers and running various comparisons, it is very easy to say "Hmm, that set of numbers doesn't make much of an impact, don't bother listing it." or "Gee, those numbers make a statement but if I alter the definition of such and such to include this and that it might show it even more strongly, let's see.."

It's very much my style to go about these things backwards (trying my hand at research without really knowing my nose from my elbow with it, and then embarking on getting the academic foundation for how it "should" be done.) I can't help it, I learn well this way.  And I totally disclosed that it was an informal survey, so don't yell at me! I know I'm not a real researcher. Just one little organism pushing my own boundaries and investigating curiosities with the tools on hand.

Violence in Midwifery Part I: Intimate Partner Violence

Posted by Katy

Midwives deal with violence on a regular basis. Whether its violence experienced by the women we serve, violence within systems of health care, violence against women by providers, or violence within the community of midwives, violence should be looked at continuously in an attempt to understand it, cope with it, and curb it.

I’ve been seeing a patient in antepartum clinic that has a very interesting story suggestive of intimate partner violence (IPV). IPV is both affected by pregnancy and affects the course and outcomes of pregnancy. While the statistics of prevalence are fairly unknown, about 14% of pregnant women in the US experience IPV. IPV in pregnancy is associated with low weight gain, substance abuse, premature labor and birth, persistent STIs, anemia, vaginal bleeding, and complications associated with physical trauma. IPV is an important and relevant topic for midwives to be familiar with in order to best care for women. Intimate partner violence is challenging to fit into the process of diagnosis and management which makes midwives (and all providers) shirk away from the issue rather than dealing with it appropriately. This case study served as an important opportunity for me to become more competent in screening for and supporting women experiencing IPV.

This woman, let’s call her Josefina, came to the inner city hospital clinic where I’m doing clinicals for prenatal care. The first time I saw her she had bruises on her face that she said were from play fighting with her partner. She had been testing positive for chlamydia since the beginning of her pregnancy and had already been treated once. She said that her partner had not been treated and that they were still having sex without condoms, despite previous counseling on the importance of using condoms or abstinence to prevent reinfection. She withdrew with questioning about her social situation or the sexual relationship with her partner, and would not answer questions.

Breastfeeding: It's not even a word

Posted by Tatiana

Reading articles and making annotations just now, I experienced the transition from semi-awareness to active annoyance at the fact that every time I type the word "breastfeed," be it in my PDF annotating software, my email, word processor or yes, right here in Blogger it is flagged red by the spellcheckers. Where I can, I add it to the dictionary, but that's not always possible and frankly I don't see why it needs to be done in the first place. The spellcheckers are fine with breasts and feeding, but put the two together and it's like consciousness of modern civilization rearing its head in proclamation, "Breasts are for sex, not for feeding!" I don't make a habit of freaking out at the failures of spellcheckers, but I just reached my saturation point with this one. What gives?

Midwifery education survey

Posted by Tatiana

Daphne Singingtree is conducting some research about the experience of student midwives and precepting midwives. Take a little time to take the appropriate survey.

2010 Clinical Education Survey - Students

2010 Clinical Education Survey - Midwives

Cheers!

Unnatural Causes - More about race and birth outcomes

Posted by Tatiana

Here are a couple of clips from the documentary series Unnatural Causes. Each is valuable in its own right and I can't decide which makes a more effective statement. With just a little bit of overlap they tell the story differently and use different sets of data. So here they both are.

I'm posting them because now and again when these conversations about race happen, someone actually is taken aback by information they didn't have before and reconsiders their preconceptions on this subject. And the more that happens, the better our chance at progress.

So let's keep shaking up our perceptions. Oh yeah, and pass it on.

How Racism Impacts Pregnancy Outcomes

UCLA obstetrician and gynecologist Dr. Michael Lu believes that for many women of color, racism over a life time, not just during the nine months of pregnancy, increases the risk of preterm delivery. To improve birth outcomes, Lu argues, we must address the conditions that impact women's health not just when they become pregnant but from childhood, adolescence and into adulthood.

Kim Anderson's Story

When Atlanta lawyer Kim Anderson was pregnant with her first child, she did everything right: she ate a healthy diet, exercised, and got the best prenatal care. But her baby was born almost three months premature. This excerpt from When the Bough Breaksexplores racism's impact on pregnancy outcomes.

A little laugh

Posted by Tatiana

I'm not posting these days, though I have some nice ones rattling around my mind.  Doubtlessly that is largely due to a little something that would be called PPD if I had the health coverage to actually see a professional. Somehow all those stories I've heard over the years about the stuff that's supposed to decrease the risk of PPD - you know, skin to skin baby time, breastfeeding, being hydrated, sleeping enough, community, good nutrition, eating placenta, staying in for a month, blah blah blah - translated in my mind to meaning PPD is for people who don't do those things.

Alarming, I know, but this like almost every other unconscious assumption turned out to be wrong. Nothin' like some good contrary experience. It's a consolation to know that more than likely this experience will prove invaluable sometime in the future, but in meanwhile it's been a bit of a bear.

Anyway, this comic made me giggle and reminded me of some of the other absurd attitudes we are faced with in this work, and think of you guys over here in this rather cobwebby corner of cyberspace enough to actually pipe up.  So here it is, and here I am.  And don't worry, I'll be getting what I need.

Freely shared thanks to open licensing.  From: xkcd

The exemplary midwife

Posted by LeAnna

A discussion assignment for one of my classes this week was to write about what I think defines an exemplary midwife and the essence of midwifery care. This seemed like a good place to share these thoughts as well.

An exemplary midwife is one who embodies the Midwives model of care in every interaction she has with her clients. In order to do this she truly gets to know all of her clients on a personal level in order to keep the lines of communication open and to create trust between herself and the client. This allows her to get honest information from the client to better monitor the pregnancy and to know how to provide individualized care. She arrives at births early enough to truly be able to provide continuous care and monitor the birth to make sure everything is going smoothly and watch for signs that things are about to deviate from normal. She knows what to do to prevent this deviation and when to get further assistance. By paying close attention and having a wide knowledge base the exemplary midwife can often prevent the need for technological intervention. She also knows when a woman needs help that is beyond the scope of her practice and ability and refers her to an appropriate care provider.

The exemplary midwife has an evidence based practice, she keeps up on research in order to have a wide knowledge base to be able to know all the options and with her client choose the best course of action. She strives to obtain truly informed consent and with the exception of emergent situations she takes time to confer with her client on what the client feels is the best course of action. She discusses possible emergent situations in advance in order to know how what course of action her client would prefer. If an emergent situations she uses her midwifery knowledge and knowledge of her client's preferences to chose the best course of action.

The definition of essence is “the basic, real, and invariable nature of a thing”. With that in mind I feel the essence of midwifery care is trust. The exemplary midwife trusts birth. She trusts her clients and has faith in them that they know their body and can make good decisions. She also trusts in her abilities and knowledge. She knows that birth is not a game and that if not properly managed and monitored things have the potential to go very wrong. Though she has this knowledge she does not allow it to cause her to fear the birth process. Her trust in birth and her client helps them to trust her, themselves, and the birth process as well.