How will Obamacare change health care on Oct 1, 2013?

I am pondering just how Obamacare changes are going to change different aspects of healthcare, starting Oct 1, 2013.

1. How will this change my own healthcare insurance coverage at my hospital?  They have yet to announce this to employees.  Will we change to the new insurance purchase methods?  How expensive is it going to be for employees?

2. How will this change our RN staffing on L&D?  Will it cut out more money from the department budget, creating a loss of jobs?  Will there be more income into the department, creating more RN positions?

3. How will it affect physician/CNM reimbursement?  Reimbursement from insurance companies have been declining in the past 20-25 years.  What an MD used to make from doing one surgical procedure has dropped dramatically.  (I recently was having a discussion with a physician about this at work.)

4. Will more NPs/CNMs/PAs be implemented into the new healthcare system to help save money?

5. With more people being able to buy in to the healthcare insurance exchanges (i.e. more Medicaid??) will we see in influx of more people coming to the hospital for urgent/emergent care?

6. How will this affect hospital billing and reimbursement?

7. Will smaller physician/CNM practices combine into the hospital system and become hospital employees?

8. Will I ever find a job as a CNM in this market?

Nashville conference --- how-DEEEEEEE!!!

I had an absolute blast in Nashville for the ACNM conference!  I had my list of which seminars I wanted to attend -- adjusted it as necessary for adding some downtime that was much needed.

We hit Margaritaville --- twice!!  Great place to eat, drink, and spent time with old and new friends.  Oh, and shop.

We also went to Loveless Cafe for breakfast.  Several times.  Yummmm, biscuits and sausage gravy.  :-)  I could seriously eat that every day.  More shopping at the little cafe shops at Loveless.  Yes, I did buy some edibles!  Biscuit mix, preserves, peach BBQ seasoning, just to name a few.  I think I'm going to need to go online and buy some more (especially the cajun bacon -- heaven!!).

I did some window shopping for authentic cowboy/girl boots, but decided the pricetag was just too high for me.  $300-500 for boots?  No thanks!  I'll stick to my sandals.

Live music!!  All along the live music venue (about a two block area) in downtown Nashville, you hear live music playing from all of the cafes, bars, etc.  Tour buses for country music singers were a nightly occurrence along that stretch of bars/restaurants.  Don't ask me who these singers were though.  A country music fan, I am not.  But all in all, a great time.  I wish I could have stayed another week or so to just be a tourist!

We had a scheduled bus tour of The Farm as well.  I really wish they had planned for more time at The Farm.  It felt so rushed to hurry-hurry-hurry and see the prenatal clinic, a birth cabin, and shop at the Farm Store.  Back to the bus, we have to leave :-(  Boohoo!  I did get to meet and talk to Ina May.  I could totally see myself having an extended stay at The Farm.  (Side note: yes, they do have modern plumbing and electricity!)  There are currently about 150-200 people who reside at The Farm.

I stayed in a lovely rental property for the week with quite a few other Frontier gals.  I ::heart:: my Frontier sisters!  I would definitely recommend renting a large house and splitting the cost of the house, versus staying in a hotel.  Without a doubt this was the best way to stay in Nashville!

What a wild week!

It sure has been one heck of a wild week! Started out the week by attending a sex toy party. Yeehawww! Do the girls I work with know how to work their sexy! We are a bunch of wild child chicks. Well, what did you expect when you mix alcohol, food, and a sex toy party?

And yes, I bought some.

Next up.........babies galore at work! I literally lost track of how many births I was in over the past few shifts. It's just bam-bam-bam! One after another. One was an unanticipated premature birth where the labor was super precipitous and the kiddo just flew out. Literally rode a huge wave of amniotic fluid (full on in the face of the midwife and doctor at the end of the bed), and I was able to get the baby up on to mom's belly as the midwife and doc worked on wiping the amniotic fluid from their faces. A TON of fluid. Holy heck! Baby was quite stunned, and needed respiratory support and was a NICU admission, of course, due to gestational age. But babe is doing well, the last I heard. The mom was awesome. Totally awesome! She did it with no drugs.

Speaking of natural births, I had another one the day after that. Mom had pitocin augmentation, didn't want any pain medicine or an epidural - and she did it! High five to that mom too! It's just beyond words when I'm present at births where the woman is determined to do it natural, and she does it. Damn! Women are STRONG!

Yet another babe after that. Another first time mom (we seem to be having a lot of primips lately), and she also pushed like a champ! Super short pushing stage! Mom felt like baby was coming OP, but babe turned out to be OA. She had a little bruise on her forehead which tells me she probably was OP, and rotated in time for her birthday to be OA. Those kids do that sometimes. Little buggers!

I haven't caught any babies recently, which is a good thing, because it's kinda frowned on nurses doing the catching. But sometimes they truly come so fast that the nurse ends up catching. Or rather, the baby lands on the bed. Yep, I've done several births like that. Which brings me to my next point........

Keeping the bottom of the birthing bed on. Yeah, I don't like breaking the bed down. That's fine if you need to break it down after the birth to see and do a repair. But for the actual birth? Heck, I personally like knowing that the bed is intact, to catch the baby, just in case he/she shoots out like a cannon at the end. Cause let me tell ya, some kids will do that.

The "dead baby card"

Have you ever had this happen to you? A provider is pushing an intervention or test on to you when you're pregnant, and brings up the "you don't want your baby to die?" or "your baby could die if we don't do ___."

I have had that happen to me. As a 29 year old L&D RN, pregnant with my 3rd baby, I was refusing the GBS screen at my 37 week prenatal visit with one of the CNMs in the practice I was going to. I had my own reasons for refusing the screen, and I informed the midwife of this, and pointed out the futility of even doing the test. (I'm allergic to several antibiotics, including the ones used to treat GBS in labor. The remaining antibiotics that could be used I would refuse, due to my own personal and genetic history concerns related to the side effects of the antibiotic.)

There I was - an L&D RN of all people - and the CNM played the dead baby card with me for refusing to do the GBS test. I point blank said to her: "do NOT play the dead baby card. I know my rights to refusing testing, and I know the signs and symptoms to be on the lookout for with a potentially GBS-septic neonate."

I was planning a hospital birth, with no interventions (didn't need any of them), no IV, and an early discharge to home. I honestly would have had a homebirth if my health insurance would have at least paid for part of a homebirth. Unfortunately, the insurance would only pay for a hospital birth. Financially, it was just not going to happen about a homebirth.

Looking back on my birth, I was able to give birth precipitously, with no interventions other than minimal fetal monitoring. I had absolutely no complications with her birth, and no complications in the postpartum period. I went home in 24 hours (would have gone home sooner if the darn pediatrician had actually rounded early in the morning!).

I'd like to also note, that before anyone jumps on me about refusing GBS testing, I ended up allowing it to be done at my 38 week prenatal visit, with another midwife, who actually understood my rationale for not testing. She knew I was going to refuse any antibiotic coverage due to my severe drug allergies, and the last drugs left (vanco or gent) I would have refused. It would have not been in my system long enough anyway, due to my history of rapid birthing. (I gave birth maybe an hour after arriving at the L&D unit.)

Oh, and all of that fuss and dead baby card talk? I was GBS negative at the 38 week visit. So it was all a moot argument. (See the screaming Mimi in the above picture - healthy 6 lb 9 oz baby girl, just minutes after her birth.)

(On the topic of refusing testing, I also refused the 3 hr glucose tolerance test after my 1 hr test was slightly elevated. I checked my own random blood glucose levels, and was very strictly following a diabetic diet throughout the pregnancy. I also refused the erythromycin ointment in the baby's eyes after the birth. I'm also the "annoying" woman who refused to let her baby go to the nursery and insisted on non-separation of mother and baby after the birth.)

International Midwifery Week

Happy International Midwifery Week!!

Have you hugged or thanked your favorite midwife (ives) this week?

What are you doing this week to promote Midwifery?

Midwives in Haiti

I just read an amazing post at Women in Charge about her first day's experience in Haiti working with Midwives for Haiti. I am just astounded at how little medical supplies are available on the maternity ward.

To think, in the United States, we complain and moan and groan about things that are impossible to even dream of obtaining in Haiti.

Could you imagine bringing your own supplies with you to give birth? A bucket to catch all of the birth fluids and your own waste products in, your own linens to lie on while giving birth, having to purchase your own IV tubing and medications in advance?

We are truly blessed to have what we have in this country.

Some self loathing, some guilt, and a whole lot of venting

So, after watching BOBB (The Business of Being Born) and doing my current reading about the history of midwifery/hospitals/medicine, my eyes have been opened, yet again (still!) as to how harmful the hospital environment can be towards childbirth and women.

Yes, hospitals, medicine and nursing care can save lives. However, ever notice the trickle down effect of us *causing* some of the problems in the first place?

I have been guilty of thinking far too medically as a nurse on L&D. I feel guilt for being that medicalized thinking nurse. I'm not talking about truly sick people, I'm talking about normal labor and births.

As a new nurse, you're taught one way. You are more than likely fearful of retribution or a good scolding by other nurses or the almighty physicians if you don't do as your told. After all, those people have the experience, so they know what's correct, right? So, the new nurse will pit-pit-pit the mom til she is begging for an epidural. Or until the baby crumps. After all, the doc is bugging you, telling you to keep "upping the pit!".

Then you start to gain more experience. You realize, you have more autonomy than you thought. You need to look at the entire picture. You have control over that pitocin. You do not have to "up the pit" to distress (maternal or fetal). You assess and reassess the entire situation, continuously.

Where am I going with my rambling? I don't freaking know. All I know is, burnout is approaching. I'm doing my best to diffuse it and process it. I see so much medicalization of birth that it sickens me. I can't fix everything. I can only advocate one woman at a time.

What really goads me: a woman presents for induction of labor at term. She gets a prostaglandin gel placed for cervical ripening. It works too well, causing tetanic contractions. The baby crumps. We work to fix the horrendously long contraction and help the baby recover. The worst part of it all? She and her husband verbalize that they have *no clue!* why she was being induced. NO CLUE. She's not overdue. She's not having pregnancy complications. No medical complications. Just a normal pregnancy for a normal woman. WHY did they go along with the induction? Because the doctor told them they were going to induce her labor. Yes, full and complete trust in the physician. No informed consent on what the induction actually entails, and the risks involved. They had no clue that something like this could happen (and does happen often, especially with certain physicians).

Do you know how many times the above scenario happens where I am? All the freaking time. Sometimes several times a week - that I know about. Mind you, I'm only there 4 shifts per week. What's going on the rest of the week? Same shit, I guarantee it.

Our maternity system is broken. I'm sick to my stomach about how women and their unborn babies are subjected to such bullshit that they do not need and that actually cause negative effects.

I'm really, really trying to hang on here. I know that I can (and do!) make a difference in women's births. One woman at a time. I can't help all women, though I wish I could. I question physicians, and even midwives, on their rationale for doing this or that. I am very careful about adjusting pitocin infusions. I labor-sit my natural childbirth ladies. I give verbal and physical support and encouragement. I educate about options, pros and cons, and allow the woman to make the decision without my trying to sway her one way or another.

You don't know how tempted I am, sometimes, to put in a request to transfer to a different department in the hospital. Some place where I am not working with such a vulnerable population. But that's the easy way out folks. That's running away from the problems. That won't fix a damn thing.

So I stay. I vent. I blog. I eat chocolate. I drink alcohol from time to time. I exercise. I hug my kids. I paint. I read fiction books.

I plug away at my midwifery education, so that I can someday be a better provider than what I am and what I have witnessed.

xoxo
AtYourCervix

Why Choose a Midwife: update on the video -- UPDATED AGAIN

From the Our Bodies, Ourselves website:

Our Bodies Ourselves, like many other birth organizations and activists, has long believed that all birthing women should have access to midwives and to a midwifery model of care. A new video, “Why Choose a Midwife?” provides an overview of this model and serves as an advocacy tool for midwifery.

Our own Judy Norsigian was interviewed for the piece, and explains the Our Bodies Ourselves position on choices in childbirth:

We want to have more women having vaginal births after cesarean available in the hospital setting, we want to have more certified nurse midwives in the hospital setting, we want to have more trained, licensed midwives in the home birth setting.

She also acknowledges a woman’s right to make her own educated decisions with regard to childbirth, explaining that “women and their partners choose the risks they want to take when they choose a home birth or they choose a hospital birth.”

Other topics covered in the 12-minute film include safety, home birth, the problems with some routine hospital interventions, the attention provided by midwives, cost, and choice. Also featured are Gene DeClerq, PhD (Boston University School of Public Health) and Marcie Richardson, MD (a Massachusetts Ob/Gyn), with additional footage graciously provided by other filmmakers. A volunteer film editor, with guidance from a group of volunteers from Our Bodies Ourselves and Massachusetts Friends of Midwives, created the piece.

Although the film is somewhat focused on Massachusetts, those interested in adapting the video for their communities can contact June Tsang at junetsang23 at gmail dot com.

Technical difficulties: We apologize, but needed to take the video down at this time.

At Your Cervix here -- Something is very fishy as to the *why* this video was taken down. I hope that Our Bodies Ourselves can please clarify the REAL reason. It seems very fishy. Was there pressure to take the video down? It's a very pro-natural, pro-midwifery, pro-homebirth, pro-women's choice video. Sorry if I sound highly suspicious, but let's face it: midwifery has been a battle for CENTURIES. Certain people of higher power want to remain in a higher power over women's health care. Midwives and midwifery supporters want for women to have the power over their bodies. This video even has physicians who support midwifery - imagine that!!!!

The only other option I can think of is that this video has gone viral with it's support of midwifery, and the bandwidth was overloaded from so many people viewing this video and reposting it. I have posted the video here. I have seen this video posted on other blogs. I have seen it posted and reposted on Facebook.

UPDATE on the update!!! This is from Rachel, at the very first link on Our Bodies Ourselves:

"Sorry, folks. The video included several clips from other films on midwifery/birth for which permission was given to include them in the film. However, after we posted it we found that there was one portion of the clips that had been cleared to include but not to post publicly. If we can resolve this issue in some way, we’ll repost. We’re thrilled that you liked it, and apologize for any inconvenience!"

Thank you very much Rachel, for letting us know what the problem was. I hope it can be rectified soon, or edited, so that we can view the video again. ~~AYC

Why choose a midwife?