Friday, April 16, 2010

The Allure of Likeness

      Oh how we love to be alike. Isn't this how we connect with one another, search for the things we have in common and latch onto them like life rafts; all of us, adrift on this ocean of life; tides of fear, joy, perspective, experience, pulling us this way and that. Of course we want to find ourselves among "likeness". We recognize ourselves in others, we want them to see themselves in us. We get to know ourselves better this way.
   But..... it can be a challange to be true to ourselves. To stand out, to not only display our differences, but to champion them! Isn't our ocean littered with cast aways, wreckage, and rubbish? Who among us hasn't abandoned one ship of self for another, more acceptable, socially appropriate mode of transportation?
    Years ago I began to recognize the ways in which people connected with one another. I became distrubed when I began to understand how negative the threads of similiarity we used to sew our relationships together are. I noticed, in the groups of people I associated with, how common it is to connect through our traumas, wounds, and negative experiences. We like to share our difficulties and display them like costumes, choosing which to don by looking at those around us, comparing our scars, and grouping ourselves with those most like us.
   I bring this up, one, because I often think about it, and two, because I've been thinking about it in relation to my work environment. The allure of likeness is strong. Even though I have spent many years cultivating my awareness of negative habits of connection, I still find myself drawn into the web. Although I am often able to seperate myself from the negative comments about patients/family members/Doctors/nurses, I do slip into it now and then. Icky!
   I recognize the need to vent is strong, and often appropriate. Some situations require a release and sharing with colleagues can be healthy and help to build strong relationships. But much of what goes on is out of habit. It is just too easy to label others, to bond with one another through shared perspectives, to create a circle of "we" by creating a boundary for "them".
   I don't want to loose my perspective and become a part of the common ship of likeness, like the members of Davy Jones' crew in "Pirates of the Carribean". I want my relationships to be woven with threads of positive commonality and difference. I want to be able to use sarcasm and labels occasionaly, because I enjoy humor as a method of healing and communication, but I want to maintain my awareness of the tide that carries me. I fear, if I do not, I will look out at the horizon one day and find myself lost,  woven into the fabric of a ship I did not want to be on, traveling in a direction I never wanted to go.

Monday, April 12, 2010


      I feel comfortable at work. There are many, many things I've yet to learn, and bits of paperwork I miss every once in awhile, but I feel easeful with the work itself. My experience as a doula and familiarity with the  birthing process may have much to do with it, but somehow, I feel it is more than that.
   I think I am doing what I am meant to do. I have followed my passion and it has led me here. And as I continue to follow my passion, I continue to find myself greeted with exactly what I need. I have an openness, a willingness, a desire to meet each moment with my full attention and presence. I want to learn, I want to fullfill my potential. It is good to do what I love.
    I am learning about my own limitations, areas in which I need to pay more attention, things I need to spend more time on. I know that today I forgot to share some information in a report. I assume there are elements of the massive amounts of paperwork that I most likely failed to fill in properly. I am confidant I did the majority of the work well and correctly, but I am aware of the great possiblity for missing something, or multiple somethings as the case may be.
   I did a blood draw today. I successfully filled the tube, which ended up being the wrong tube. Thankfully I did not need to do another draw. Unfortunately the site infiltrated, which means the patient ended up with a hematoma and bruising. I felt badly for her. It will probably be pretty painful for awhile. But I was proud of myself for the successful draw! I look for successes where I can.
   I find myself comforted when experienced nurses encounter the same difficulties as I. For instance, today, for some reason, I could not get any of the thermometers to work for me. One after the other they didn't work. I've been using these same thermometers for weeks. I wasn't doing anything differently today. I couldn't figure it out. I asked my preceptor to try using them and she was having the same issue as me. It made me feel better to know it wasn't just me doing something blatently wrong with something as simple as a thermometer. Other times I can't figure something out, like how to program a pump that's different from all the other pumps on the unit and completely new to me, so I mess with it for a few minutes, then have to leave the room and ask my preceptor for help. Most of the time I handle these situations by using humor, poking fun at myself, etc. I don't worry too much about it. It doesn't bother me a lot. But I don't like to appear clueless to my patients. I want them to feel confidant in my ability to care well for them. To trust in my competence.
  So far it seems they do not mind my small blunders. I think my honesty helps to put them at ease. We shall see.

Friday, April 9, 2010

REACHE Conference.... more stirring the BirthNurse thought pot!

   Today I attended the REACHE conference. The presentations/speakers were enthusiastic, entertaining, and informative.
      I must admit I love me some research! Interestingly enough, I also enjoy data, statistics, and in particular... Evidence Based Practice (EBP). Several years ago I attended another REACHE conference where Henci Goer  (   was a presenter. She is a well known proponant of evidence and research in childbirth, but she also is very clear about how the data can be interpreted/misinterpreted and learning how to interpret research.
    Over the first few years of my doula career I picked up tidbits of research, data, EBP like I was flypaper and I became aware of the vast quantities of conflicting data and the lack of EBP in childbirthing. I began to cultivate an understanding of the ridiculousness of attempting to apply data to an individual woman. There is no real way to extract research from a particular study or even a group of studies that can be reliably applied to a particular situation and result in an expected outcome. People don't work that way, birth doesn't work that way. But many elements can be integrated into the way we approach caring for birthing women as a population, especially in the implementation of practice on a systemic level, as in hospitals, physcian/midwifery clinics/practices, etc. That is why we do these group things, form collaborations, beg for research money, because we want to change more than just one person's experience. We want the best for everyone, or as close to the best as we can get. But how do we know what's best??
   As one of the speakers at the REACHE conference alluded to today, as human beings we naturally chose things that meet our needs. With the internet at our fingertips we can easily find "research" that supports any view we may want to champion. Or even better, any practice that we want to adopt, or more likely, a practice that we are comfortable with and do not want to change!
    As I gathered more information, and attended more births, I began to change the way I talked with clients, instead of citing research that supported certain choices.. i.e. non-pharmalogical interventions, breastfeeding, etc. I began to cite research with the caviate "of course these studies don't necessarily apply to any individual, every experience is different", or something along those lines.
   As always, applying science to human behavior is a tricky business. This brings up my beef with Darwin, but I'll have to save that for later. Although birth is a physiological process, that is just one of it's many facets. Birth is also personal, emotional, familial, cultural, societal, public, private, the list goes on.
    Birth not only entails the individual experience of a woman having a baby, it also encompasses a fetus (or multiple fetuses), a family (however that may be defined), the care givers, attendents, and the combined experiences of all those involved, however indirectly. In other words we bring the entirety of ourselves into every situation we encounter, and so does everybody else! (How well we are able to seperate out the elements of ourselves we wish to display/use, and how each influences the other is a topic for another day). Not only is birth a complicated, unpredictable physical event, it is also a complicated human event, and it carries with it all the mess, misunderstanding, and uniqueness of all of our humanness.
   No Wonder we all have so much invested in Birthing. We have big feelings, big opinions, and big investments in Birth because it is a Big Deal!

Sunday, April 4, 2010

A good day

     During my last shift on the L+D unit I attended the birth of a couple who chose to birth without medications. They had taken a 12 week series of childbirth classes and were working with midwives. The patient and her husband arrived early in the morning after several days of laboring at home. She was 7 centimeters. The few hours I spent with them were wonderful.
    I got to integrate my doula skills with my nursing skills and provide direct care to the patient and her husband. He was wonderful, supportive and present. The midwife was calm and unobtrusive. My preceptor and I worked well together. She allowed me to do what I could do, checked in with me periodically, and took on the roll of "baby" nurse when the baby was born.
    My patient spent some time in the birth tub during her labor. I used a doppler to listen to her baby's heart tones and used my hands to palpate her contractions. I performed a few cervical exams to check her dilation. She had the urge to push for quite awhile, while she still had a bit of cervix left. Not too long after I performed an exam my patient was saying she had to push so I asked the midwife to come in and check her, with the patients consent of course. The midwife examined her and and her exam was the same as mine. This was very validating for me!
    You may or may not know that cervical exams are very subjective. Women's cervixes do not dilate in perfectly concentric circles, care providers and nurses have different sized hands, perform exams differently, and have different interpretations of 0-10cm. Baby's do not apply the same kind of pressure, in the same spots, and cervix's can feel different from exam to exam, actually when a woman is in labor you hope that they feel different, change is good, but it can be tricky when you have multiple examiners. (The topic of the necessity, or not, of cervical exams is for another day!)
  That being said, as a new nurse, and a new cervical "examiner" it is helpful for me to know my exams are "accurate", although accurate may not be the right word. So the few times I have had providers do a check after me I have been glad to know they come up with the same results as me.
    It was a great birth, a great way to start the day. Things went well for the patient, her baby, and her husband. They were happy, glowing, and exhausted. They kept telling me what a wonderful nurse I was!
   So wonderful! How gratifying and validating. I made a difference for them. They had the birth experience they wanted, in fact, at one point, she told me her experience in the hospital was better than she had hoped for! How amazing is that!
    It was a good day!


           After three twelve hour shifts in a row last week I found myself pretty dehydrated. It's one of the unfortunate results of being watched by the Joint Commision/JHACO, we are not allowed to have personal drinks at the nurses stations. We can have them in the break room and/or in the charge nurse's office. It takes some coordination, and time to get to a drink of water. Plus, I happen to like coffee, so I drink that during my breaks as well, and end up becoming even more deyhdrated because of it.
           My astute husband has suggested I try bringing electrolyte drinks with me to work and sipping on those throughout the day, when I get a chance. So I am going to try that this week and see if it makes a difference. I am also going to remind myself to get as many sips of water in during my shifts as I can. Every little bit has to help. Right?