Midwifery: October 2003 Archives

another UN issue


Catholic World News : UNFPA complains Philippines diverted funds for contraceptives to NFP.
Apparantly, UNFPA thinks that the only acceptable family planning methods are those that enrich the drug companies.



Thank you all for your comments on my blogger's lament. I wan't able to post anything yesterday - the computer I usually use when on call was misbehaving, and I also had a couple of patients who kept me busy. Some patients want or need an almost constant presence when in labor, but many others do better if I leave them in control of deciding when they need me - I think that labors do better if left alone to follow their own rhythm. I don't manage labor, I support the family in working with it. I see myself as more of a guide than a general.

Parenting alert!

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Toddlers Have Bad Eating Habits
How hard is it to give a kid a banana instead of a candy bar?

Save this page somewhere

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A month before Christmas 2002, I met the owner of the Carrying to Term Pages. At that time, I didn't know about her page - I simply knew that she had been an enormous support for a patient of mine who had been diagnosed prenatally with a uniformly fatal (to the baby) birth defect. I had heard about her over the months from my patient, and I met her during the labor and birth of precious Cynthia.
This afternoon, I met her again at the conference, and learned about her web page.
This is a great resource for women who are in the terrible situation that my patient was in.
Check it out.

Major prayer request

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Ashli is pregnant. She also has hyperemesis gravidarum. She is trying to keep a blog of her experiences. Please, please, pray for her. Blessed Gianna, watch over our friend and strengthen her in her resolve with this difficult pregnancy.

Let's be militant

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The sleepy mommies had a comment (in Bill Luse's recent post) about the Militant Breastfeeding Cult. So I bopped over to check out their website. Wonderful, wacky, and supportive. I could have used that kind of support years ago!

Still tired


Thanks for all the prayers. I had another brutal call night last night. I ended up only sleeping between 0430 and 0600 (this was after being in the office all day, meetings until 10 PM, and a truly emergency cesarean at 0130 or so).
I can only hope and pray that the pace will slow down a bit over the next few days, but I am not optimistic. We are averaging 25 births a month the through Feburary......

I know I am tired _ just checked out a few comments I have made on other blogs and I totally missed some pretty egregious typos.
Thanks to all of you that have been stopping by to check in. I have been busy and exhausted. Last week (9/27 to 10/4) I did a birth Sunday at 0700 after an all night labor, attended births over lunch (and after seeing patients in the office the morning and afternoon) on Tuesday and Friday. I also supervise a resident clinic (in addition to seeing my own patients) on Tuesday mornings, supervise a nurse-practitioner student on Tuesday and Friday afternoons, maintain the High-Risk pregnancy list and attend the weekly meeting Friday mornings. I was just appointed to a committee to work on JCAHO certification for our methadone program for pregnant addicts, and that meeting is every other week at 0730 when I am just getting off call. Add in the monthly OB staff meeting and the residency faculty meeting, the office staff meeting, the office clinical management meeting, and I am fried by the end of the week.
Will you all please do me a big favor? Pray for those of us in health care? There are so many pressures on us to be 'productive' (i.e. bring in money) that sometimes I worry that the patient is going to get lost in the shuffle.
I truly do try to see my patients on time so that no one has to wait forever in those skimpy gowns in a barren room. Your time is valuable - I try to run on time. I truly do try to take the time to listen - to hear not just the first layer of the problem but also the stuff underneath. Sometimes these two goals are in pretty direct conflict.
Labor, as in to give birth, is usually pretty time consuming. It is an effective process, and God designed it well. But it is not always efficient in terms of time. The package charge for prenatal, birth, and 6 weeks postpartum is what is called a global fee. The provider is paid the same regardless of what time is required. Lately I have felt like I was being torn in thirds (or more) because time spent with a mom in labor is time not spent in the office seeing other patients, and the economic pressures are incredible to ignore the labor patient (manage by phone and through the nursing staff) in order to see the paying patients in the office.
One effect of this is that many women are encouraged to have their normal labors intensively managed, so as to time the process in order to maximise the productivity of the birth care provider. A normal but slowly progressing labor may be speeded up, a fast and furious labor slowed down. Fortunately most moms and babies have enough resilience to tolerate this kind of intervention. I will confess that I have felt these pressures too - I try to resist them but when I am tired it can get so tempting........and when a mom comes in asking for all the intervention it can get pretty tough to hold my own.
I have been told that it takes 10 births a month per midwife to cover overhead and make a modest salary possible. We also do annual exams (pap etc), routine gynecology, and I have a small practice in PCOS and NFP as well. My home-birth midwife friends consider 4 births per midwife per month to be more than a full load.
Something has to change in the way we provide health care in this country. I don't pretend to know how, only that what we are doing is not working well either for those who provide the care or for those who are on the receiving end.


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Just back from being doula to a good friend who went to another midwife for her birth. It was great to just be able to hang out and provide labor support, for once, and let some one else have the headaches of paperwork and decision-making. It was a longish labor (16 hours) and VBAC as well - but she did it without drugs and had a normal birth, and a very cute baby boy. I don't have weight or name on the baby - my friends had picked out a girl name but not a boy name. When I left the hospital the baby was firmly attached to mom and nursing away.

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About this Archive

This page is a archive of entries in the Midwifery category from October 2003.

Midwifery: September 2003 is the previous archive.

Midwifery: November 2003 is the next archive.

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