A quickie this week, as it’s been a busy first week of the fall term!
A Science and Sensibility post by Henci Goer explores the evidence on that typical 20 minutes of fetal monitoring that most women are subject to upon admission.
The crucial question, though, is whether increased monitoring and surgical deliveries produced better perinatal outcomes. To that, the answer is “no.” Combined fetal and neonatal death rates in infants free of congenital anomalies were identical at 1 per 1000 in both groups (4 trials, 11,339 babies). The reviewers acknowledge that their meta-analysis of over 11,000 babies is still “underpowered,” i.e., too small to detect a difference in outcomes. However, they continue, the event is so rare in low-risk women that no trial or meta-analysis would likely be big enough to do so.
I saw this headline and was hopeful that it would be a thoughtful exploration of language and the complexity of pregnancy experiences…but it somehow fell flat for me. I think my work with Backline has instilled in me a deep trust that a so-called singular experience can have multiple layers of reality and language and meaning…and that we don’t have to be tied to the either-or feeling that Alana describes:
But the issue I’ve come across recently is what to call what a pregnant woman is carrying without betraying some very strongly held beliefs about reproductive health and rights and what I truly believe makes something a baby or a child. And when I hear someone very early in pregnancy refer to “the child growing inside of me,” or similar, a red flag goes off in my head about the way we discuss women’s bodies, pregnancies, and babies.
So how do I celebrate the women who will become mothers without implying to those that terminate that they destroyed a child? I considered using irreverent terms like “the bean” or “the little critter” so that I don’t have to say “baby” but that seems like a cop-out. It also reminds me of those amazing children’s books about that goofy character, so aptly named Little Critter. I’ve thought about referring exclusively to “your pregnancy,” but that’s so cold and medical.
My first thought upon reading this was to think…”Why don’t you just ask the pregnant person what they want you to call it?” Is that really so hard? I don’t know, maybe I’m missing something.
An interesting campaign. As a future midwife and current pregnancy options counselor, this question makes sense to me…but I wonder what other questions might come up for those of us not in midwifery care or women’s health.
The Oregon Foundation for Reproductive Health is pushing primary care doctors to ask every woman one extra question when they see her for a regular checkup: “Do you want to become pregnant in the next year?”
Unlike the questions, “Are you sexually active?” or “Do you need birth control?” the wording of the question “Do you want to become pregnant in the next year?” allows a conversation to start with doctors and women who both do and do not want to become pregnant. For women who answer yes, doctors can give them preconception counseling and talk about staying healthy during pregnancy. For women who answer no, doctors can talk with them about contraceptive options.
This term of nursing school is focused on chronic and end of life care. I have more thoughts coming on what this means to me in the context of my future work as a midwife…but the first thought that comes to mind is that end of life care is not all that much different in my mind than midwifery. Different situations and populations yes, but similar needs for compassion, choices, informed consent and attention to disparities.
Among hospice patients in the United States 83 percent were white, while merely 8.5 percent are African-American, 6 percent were Hispanic and less than 3 percent were Asians and all other minority categories, according to a 2012 report of the National Hospice and Palliative Care Organization (NHPCO).Yet enrollment in hospice care has grown since Medicare first began offering hospice benefits in 1983, with nearly 1.7 million patients receiving services in 2011 — roughly 45 percent of all deaths in the U.S., according to the NHPCO. Barriers for African Americans, Latinos This comes as no surprise to Virginia Jackson, chief of chaplaincy at the Palo Alto Veteran’s Administration Medical Center Palliative Care Clinic.“With African-Americans, because of trust and fear issues, we take care of our relatives at home,” she said. “The issue of trust–not being listened to, not being important–is a big issue with the African-American community. There is a lot of fear around trusting a physician around medication; fear of becoming addicted or fear that it may take them out.”