Saturday, November 26, 2011

Women's Right to Choose

            I'm happy to say that I have completed my last day as a labor and delivery nurse...or so I hope.  As I have spent the last six months working as a labor and delivery nurse while sorting out my future work as a Nurse Midwife, I've come to view the hospital setting with new eyes.  Midwifery school has changed me and in ways I never dreamed it would.  No longer do I enjoy the many tasks nurses do on a daily bases, while getting little thanks for the hard work.  I long for the complete attention I can give to women during their time of change.  However, I feel comforted in knowing that I gave 100% to the few women under my care in the hospital.  While the word "hospital" may give you a feeling of nausea justing saying it, it really is an alternate universe.  A building filled with it's own ethics and personalities to boot.  There is a certain art and finesse about navigating these complex systems in a hospital.
             I've never really realized how much hospital policies dictate how women will be cared for, or even how physicians will practice.  I recently encountered a woman who wished to have a VBAC and because the hospital policies did not support this practice, she had to hold out to the last minute to come in to delivery her baby.  Boy..did this rough up the feathers of the nurses and physicians....Nothing pisses off a doctor or nurse more then a woman who actually has a say in her own care.  It's the illusion that you will get the birth of your dreams...that is...if you do what we tell you...really?..In this particular case, she was an excellent candidate for a VBAC (Vaginal Birth After C-section), but because of the American College of Obstetrics & Gynecology's statement about VBACs a couple years back, hospitals have also changed their policies.  As well as insurance liability coverage for those few physicians still holding out.  So the big question is are VBAC's safe?  I would encourage you to make up your own mind on this...meaning read some literature on the topic.  So what is really behind all this hoopla?  Well..I'm not surprised to learn its money.  Hospitals make more money with c-sections.
             This is where I don't want to confuse you, yes there are some situations where a woman is not a good candidate for a VBAC...please also look up those reasons too.  I'm telling you to look up the information for yourself, because its important you educate yourself on the matter.  If you don't know about your options, it is to easy to be persuaded in one direction.  I'm happy to report this gal got what she wanted, much to everyone else's dislike for her deception.  When I sat down and visited with our manager about this situation, she said she supported VBACs, but didn't like how this gal deceived everyone.  I replied with..what choice did she have?  The hospital makes it's policies and women are forced with guilt and scare tactics to abide by them...and for what?...for control and to make money. It is situations like this one that I am reminded of everyone's motives in the baby biz.  I"m not saying all hospitals are bad and are out to get you, but in certain situations, hospitals are necessary for the safe delivery of babies.  However, the words safe, money, access, and ethics have all been used interchangeable enough that confusion has set in. I say this with the experience of seeing what goes on in a hospital from a nursing perspective and with the knowledge of doing my homework on the matter, and as an advocate for a woman's right to choose where she will give birth, how she will give birth, and what is deemed safe to her.
              I think when it comes to deception, hospitals can be the biggest deceivers in this matter.  You will get what you want only if these conditions are met (A thru Z). The skill of the she comfortable with you having no IV, is she comfortable with you walking around, is she comfortable with what she is seeing on the fetal heart monitor?  (Yes, machines are not 100% accurate).  Does the hospital have enough blood products to replace lost blood in a post-partum hemorrhage?  How skilled is your physician with forceps? Do you have a history of post-partum hemorrhage?  How busy is the labor and delivery unit?  Do the nurses have multiple duties other then to care for you?  This will all play into what kind of care you will get?  Your provider will also be thinking of these things when discussing your delivery.  Like I said....alternate universe.
               So what is my angle?...It is this..I will continue to support a woman's right to choose and educate those unknowing individuals working in this alternate universe of complex systems.

Wednesday, November 16, 2011

Passion in the Eye of Feminism

"Woman is the first Environment"  Katsi Cook, Traditional Midwife

          If we are fortunate enough, we get to experience a level of passion for the work we do and have the ability to share it with others.  It would be selfish of me not bring to light those who have worked so feverishly, so that women today could experience a level of "knowing" that has never been experienced before.  For if it wasn't for their passion where would we be today.


          Six Nations Aboriginal Midwives

Lesley Paulette, Midwife

Ursula Knoki Wilson, CNM

           These women here are exemplarily examples of passion at it's best.  They turned there vision into a reality and have made a path for us to make our way.  They have all made it their life's work to educate   and be an example of how to weave a beautiful tapestry of cultural practices and modern medicine.  They continue to do this in a positive way filled with integrity and the beauty of our cultural knowledge. I count myself blessed to have been in the presence of each of these women and to have been counseled in a manor that I feel they are all my grandmothers.  Grandmother, does not mean what you think it means.  These women are my grandmothers because they have walked the path I am on, they are knowledgeable and express a level of "knowing" that they are able to share, and they do it with the grace of our ancestral mothers that is hard to find today.  I can only hope to pass on this level of "knowing" to my daughter and Native American midwives who have their own path to walk.
         While attending a conference in Canada, I had the pleasure to meet women from all different parts of the world.  It was here that I realized "midwife" means different things to us all.  It is in our diversity that makes us strong and to have the ability to view life in a different perspective.  It was so empowering to see and meet more indigenous women like myself who are making strides to bring traditional birth practices back to there communities.  It is when I was able to sit and talk with these women, that I felt so honored to have been able to hear their stories. This is what I learned.....If we are able to see beyond our own pain and hurts, we have the ability to make change.  We are never alone in this.  

United we stand in the face of diversity to make change for the future...

From our your granddaughters, we are listening....

Thursday, November 10, 2011

Titles And The Work At Hand

             Spent a rather long day being a part of varies conversations surrounding why I became a Certified Nurse Midwife.  I felt like I had to tread lightly in discussing my reasoning, as to not diminish the importance of the work "Midwives" do in general,  despite my educational background versus those who have chosen a different one.  If your a Certified Nurse Midwife or a Licensed Practicing Midwife, or a Direct Entry Midwife, or a Registered Midwife, or a Lay Midwife, or a Certified Professional Midwife...this means you.  So many titles, when really we all "Are With Women" and we've all contributed to the advances in our professions.  This is a very difficult subject for me to discuss with this community of midwives right now.  I've found that my interactions with those who have variations in educational training to be very hostile, when really there should be none.  Attending this conference has been an eye opener for me, because somehow I am being viewed by "others" as being overly educated and medicalized because of my CNM training, and I'm also getting quizzical looks from women of different cultural back grounds because I'm Native American   It is all very disturbing to a woman and individual (minus the educational titles).  Despite the unsettling feeling I get while discussing my Native American views on women's healthcare and what their needs are, I feel like I'm constantly deflecting competency associations with educational training to those other then CNMs.  The minute I start to explain myself...and I shouldn't have to really, because automatically it becomes about why I feel my training should be held in higher regard.  When really, its not even about that nor did I ever say those words.  But some how..they automatically associate that with my CNM training.  This is what really turns me off from midwives who feel they need to "define" midwifery for "everyone" and if you don't fit into this box..your are not worthy to practice midwifery.  The interesting thing is I hear this from CNMs and CPMS, who are so used to defending their roles in women's health to physicians.  Let me tell you...I'm not going to play the game.
           I've always believed quality work will speak for itself and I've known amazing women from tribes and communities who have done amazing work for their communities without the title of MD, CNM, CPM..or PhD.  Which is why I have conflicting feelings sometimes on whether or not I should get my PhD.  Questions I ask myself..Do I need it to accomplish my goals?  What do I want to do with it?  Will it put me at the decision making tables that matter the most to my people?  Will it give me the ability to work autonomously?  Will it in hence my ability to help my tribe and the women in my community?  Education is a tool and allows for me to function in another world, the academic one.  Native Americans have already had to fight an up hill battle to maintain their "identities."  Why not use the education that is available to meet the many needs of our people.  We have the ability to make changes to the standards that have been set up without our input.  Our insight is valuable and needed, because right now the focus is on our "title" rather then focusing all our energy to providing culturally congruent care to women in our communities. Providing care that meets THEIR needs, not ours..
             In order for me to meet the needs of my people I had to get CNM training.  Native American women have many health issues, and when it comes to providing that kind of care, it has had to happen in the hospital.  Traditionally, home birth has selected out for women who are educated and healthy.  That is just the nature of the work, but I want this model of care to be available to Native American women.  I want them to be healthy and take active roles in their own health.  They deserve the option to birth in a birth center, in their home, in a hogan, in a hospital, but in a cultural way that meets THEIR needs.  I am committed to pushing this forward and I will get what ever training necessary to ensure that, that is what they get. Consulting with physicians and having positive collaborative relationships with them or them with us is vital to this process! Because right now... our women deserve more then what they are getting.

             Aside from conversations about educational training, I've also had some amazing conversations with the Six Nations Midwives...and you know what..THEY GET IT! And..they are Aboriginal Midwives..not CNM..not CPM.. They are able to access and use their traditional knowledge and birth practices to create an atmosphere that is un-like no other.  They are able to use traditional herbs for pregnancy, labor, and post-partum.  And no, these herbs can not be bought in a health food store.  They get what birth is about, they get why traditional knowledge needs to be included, and more so...they see it as a sacred ceremonial event that sets a life long foundation for the well being of the mother, baby, and the community.  They see it as a rebirth and realignment with our "Life Ways." Which historically, has been systematically dissected from tribes as a way to obliterate us as people.  I am in awe of these amazing women, as well as filled with gratitude.   They have been open and willing to share their knowledge with me, which is a great gift.  They see my dream for this birth center and I am happy to say, willing to help in anyway they can.  I've been fortunate to be invited back to learn about how they use their herbs, when they collect them, and how to prepare them.  I'm also going to make it a point to learn more about our traditional South West herbs that our healers have used in the past.  I am amazed at their ability to see my dream, but also to be willing to share their healing medicines with me.  For this...I am truly blessed...

                       Six Nations Birth Center, Ohsweken, Ontario

Translation of indigenous language for use in Birth

             All the babies born in 2011...this is one of many walls

Front desk as you enter the birth center ...person is called "House Mother"

Front desk..different view

Birth room 1 & Prenatal visit room

Family Kitchen

Hall Way
Gyn Room 

Front view of Birth Center

Midwife board room

Part of Family Room

Rest of Family Room

Private Counseling room for Couples

Services:  Just a list a few....
Post-partum doula:  who cares for the new mother & father over night, who also will make home visits to educate mom on newborn care, watch the baby so she can shower, and provide support up to 6 months. ( ALL within the traditional teaching of their tribe!)
Nutritionalist: educates new mothers on traditional foods to eat in pregnancy, in labor, and in the post partum period.  They will even go to their home and show them how to cook meals.
Full-scope midwifery care..well woman, menopause, sexual education..etc..

Programs They Offer Their Community
Traditional Medicine Work shops
Traditional Parenting education
Puberty education using traditional knowledge 
Called the Tsi Non:we Ionnakeratstha Ona: grahsta 
Or Degowadihsnye Program...translates.. (She Looks after Them)
Education, Awareness, and supportive services related to Fetal Alcohol Spectrum Disorder (FASD)
                                                         (Will be assessed for alcoholism during pregnancy)
Education on Child nutrition

     Yet, again I find myself in a unique situation, but I also feel blessed to have specific people in my life who have ALL different kinds of knowledge and come from diverse backgrounds.  Because it is from them I've learned the most from.  It is rare to find a community of colleagues and friends who share the same vision and despite what our educational training is, we are able to see our work as a collaborative effort by all of us.  One that requires all of our skills and knowledge.  CPM..MD..CNM..Midwife..Traditional Midwife..Aboriginal midwife....SISTER!....FRIEND! one person does this alone.

Here is to creating a foundation of trust and unity.