beginnings...

Today I had a bit of the downs:( Sometimes I feel like life is so impossible, but usually that means there is something getting me down. I spend most of my time trying to retain the positive perspective on things, that sometimes I don't check in enough to see how I am processing all this stuff going on. So this morning I had a good cry with DH, and it relieved some of the pressure. This rotation I am on has some really hard parts to it. The issues surrounding birth in this hospital setting are huge. Often, mom's don't hold their babies for an hour or more, after a perfectly 'normal' delivery. The modus operandi here is pitocin, to make labor as hard and fast as possible, epidural so the mom can't feel the extra pain from the pitocin, and then 'git 'er done!', meaning constant cervical checks (sticking their fingers in the vagina) so they can know the instant it is possible to push, regardless of the rest period that sometimes comes between dilation and pushing. Then as women push, they are rarely given true encouragement, only generic comments which frequently border on criticism. I have been told by one of the attending physicians that the faster we can turn these rooms around, the more money we make! While this may be strictly true, to have that said in the context of a sacred event such as birth sickens me. Most of the women birthing here have had little pre-natal care, and are on public insurance. While I was told during orientation that kangaroo care (immediate skin-to-skin contact for mom and baby, no cleaning up or other stuff) is optimal for many, well researched reasons, I have yet to see it happen or even be offered. Very few moms are breast feeding, and those that are, are not encouraged to begin immediately. There have been multiple times, when I am at the end of the bed, gowned, gloved, and masked, and I have been told to "get out of the way" so the doc can rush the newly birthed infant to the table to be weighed, cleaned, measured, and examined. People make disparaging comments about bodily fluids, the poop and blood that are a part of the messiness of life, and certainly part of the birthing process. Five people who are not the mom or other people in the baby's life touch, poke, prod, and admire before mom or dad get a chance. These people are gloved as well, which is good because you want baby to be populated with the family's bacteria first, but I can't imagine what it must feel like to the infant to not have the comfort of human skin immediately, the sound of the heartbeat that was with you from the moment of conception. I am such a big believer in the concept of begin as you mean to go on, or that beginnings are extremely important. These energetic signatures carry with us for a long time.

Now, don't get me wrong, I think that birth, as a gateway between worlds, is an inherently dangerous and powerful time. It used to have high mortality rates, for both infant and mother. Now it is an extremely safe process which usually has a good outcome. I appreciate that, on multiple levels. The safety factor of today is a wonderful blessing to many. Ultimately, the outcome is healthy mom and healthy baby, at least for as long as I see them in the hospital for a few days.

I am not talking about the times when there is some degree of danger and there needs to be an intervention or the neonatalogists need to be involved. And some of these behaviors may come from over-exposure, the factory type environment which leads to better outcomes through repetition, the Henry Ford model. The shine wears off for some of the doctors and nurses who deal with it day in, day out.

It just seems to me that there is some degree of humanity that is lost when we can't greet the heralding moments of life with the sacredness that they are due. It has been said that a this time in my training I am closer to the perspective of a patient than a doctor. And that may or may not be true. I often feel that I am somewhere in between. But I can hope that I will never lose that perspective of what these moments mean to the person going through it. And these outcome measures need to include the psychological or emotional aspect as well, because I think they are failing on that end.

PS I think that it is different in some hospitals. Another hospital about an hour from here has all patients fill out a huge questionnaire about preferences from everything such as music during labor to kangaroo care to feeding preferences. I'm not sure if it is just the culture of this place, or it is what happens when the majority of women are poorly educated, and not well empowered.