Feeling Alone? You Can Sit With Us

This was a statement made at a recent training I attended. The invitation implies that you are welcome, wanted, and encouraged to join those already sitting.

How many of us spend precious energy talking ourselves out of that invitation.
Today, more than ever, we feel separated, without connections, living with loneliness and forlorn. These doubts often rule us and impact our lives in ways that might take decades to weed through.

I am too different. They won’t like me. I think differently. They wouldn’t understand my past, my present, my choices, my trauma…

Before you sit at the table, do you feel you must introduce your quirks to the group? I do. Over the past 5 months, I have had multiple provider-level job interviews where I have been asked many ‘get to know you’ questions. Below are my answers to the ‘Tell us something about yourself that you would want to change or that makes you feel uncomfortable’ questions.

“Sorry, sometimes I say what I am thinking. I am a bit spectrum and I don’t always catch cues. I’m not very good with big change. I do get overstimulated sometimes, but if you give me a minute it gets better. I’m not always good with authority, I might complain first.”

One of my interviews started with a pretty hefty game of phone tag. When we finally connected, the other person was light-hearted completely disarming. We laughed about our game, and they expressed how glad they were that we finally met. I felt welcomed at that table.

Contrast that with the moments we have walked into a room without engagement. It doesn’t take long for those negative feelings to come up, for the excuses to pile high, and for your mind to convince you that you are not welcome. We have all been there. We assume the lack of welcome is judgment.

I have literally had to repeat to myself, “No one is talking about me. No one is judging me. I am worthy to be here.”

I envy those who have the confidence to welcome themselves to the table. I am grateful for those who look for a moment to connect. Those who wave you to a seat, welcome you with a smile, come up and say hello. I have been blessed to have people who genuinely welcome me to sit with them when I do not feel the need to explain why I don’t belong.

It is really amazing what a smile can do. How a glance can disarm. The priceless act of grace pushes back against self-judgment and doubt. I can only hope that at some time in my life, I can offer a sincere invitation and help someone feel the belonging that has been gifted to me.

Luckily for us, there are those that grab our hand and pull us in before we can turn away.

Next time you are invited to sit, just sit. Forget the excuses, don’t worry about the purpose of the invitation, ignore the doubt. Sit. It is the only way to know if these are your people. It is the only way to find out if this is your place. If it doesn’t work out, then focus on creating your table of belonging. Work to surround yourself with those you want to sit with. Be the smile, the welcoming glance, the outstretched arm. Create your place to fit in, and you won’t have to doubt if you belong.

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Let Yourself be Heard

I just wanted to take a minute to remind you that it is okay to be heard.

Last week, I had my first come-apart in a very long time. I had been feeling invisible, unheard, and even lonely (and I live in a house with dogs, cats, sons, and a husband).

I have entered another shift in my life, where uncertainty and change exist, and I don’t know where I fit. I was distant and grumpy, and although I was trying to push off those feelings, as they usually do, they came out.

It was dumb…a word said by my husband in jest that I overreacted to. Which, of course led to more overreaction. Even though my husband tried to be patient, gentle, and calm, I eventually pushed so hard that our communication broke down into anger and a very loud conversation.

Eventually, my feelings came out. I exploded. Everything I had been pushing away and avoiding voicing aloud came out in a destructive flood of emotion.

They poured out in sobs and ugly crying. All of my doubts, fears, and feelings of inadequacy that led me to question my achievements and worth came out.

My husband says when we try to mute our feelings, pushing them down to keep the peace, fit in, or make our wants small…eventually containment fails and we explode.

We recovered, we apologized, we talked, I said my feelings and fears out loud, and the world kept moving forward. We repaired as we have done thousands of times in the past 33 years.

If I had just trusted and let myself be heard…If I had recognized that being heard matters to our peace and that saying our fears out loud lets others love us through our struggles, it may have been uncomfortable for a moment, yes. But that moment would have passed and the come apart may have been everted.

Be strong enough to let yourself be heard!

Pushing Back Against Fear

I am not very good about guarding what I say. I am awkward and often say the wrong thing. If an act, statement, or policy is harmful, unproductive, or meant to limit my ability to improve, I tend to speak before my passion can be tamped. I have gotten in trouble for making a “thing” out of a moment and bringing a concern to light. Unfortunately, there have been plenty of inopportune misunderstandings, and my actions negatively hurt myself or others, creating fear instead of change.

We encounter fear in many forms; fear of loss, fear of harm, fear of the unknown, fear of physical, psychological, and emotional pain, fear of inadequacy, fear of punishment and repercussions for ourselves and those we love, and more.

The use of fear to align others with a specific ideology, behavior, or action is written throughout history. Fear motivates positive and negative responses and can create those responses en masse if utilized correctly. Fear can motivate a kind of peer pressure so intense that those who do not conform encounter danger to themselves and their family simply by choosing not to follow and not to be afraid. Fear shut down the world and had neighbors calling authorities on neighbors for simply being outside their front door.

I understand that fear is an amazing change agent! Targeting one person on a team, when that person is leading a policy change or encouraging transparency and a better environment for the team can quash all momentum and stop any movement toward change. Using fear to set an example works.

This is especially true in the patient care setting, where the use of coercion, threats, gaslighting, narcissistic behavior, deflection, and fallacy is used to gain patient compliance. It can happen to anyone, even the most seasoned patient advocate I know.

I encountered the use of peer pressure and fear of failure in a recent conversation with an MD influencer. This MD used her platform and personal success with an elective 39-week induction to encourage her followers to comply with her preferences. I spoke up, but the replies were invalidating, and some were downright mean because I was not a doctor. It did not matter what ACOG statement I shared (the doctor’s governing body) supporting informed choice or the research indicating the benefits of spontaneous labor in low-risk pregnancies and the risks of elective induction…I was told my experience did not count because I didn’t have the ‘right’ credentials and did not know what I was talking about.

As a nurse, I have stood at a patient’s bedside listening to their provider use these tactics to gain consent or listened as the patient is told that they do not have the experience to make medical decisions regarding healthcare interventions.

Fear is used to create doubt and compliance en masse, because if the system can make you feel like an outsider, it is easier for it to control you.

So....what is the answer?

In my experience, finding those who think and believe like you. Want a homebirth? Find others who have birthed at home. Want to give birth in a birth center, extended breastfeeding (breastfeeding > 2 years old), not circumcise your son, or make other care decisions considered not mainstream? Find those who have made those choices, and the fear is melted away with support and knowledge.

This is a special note to those we turn to for support in our choices. To those who help us navigate informed choices and our options, please remember yours is not to convince but to guide, support, and ease the fear that comes when we venture away from the influencers and followers. It is easy to become the fearmonger when you have convinced yourself that your choices are right for everyone or that you know best because of your training and credentials. We need you to push that aside and support informed choice so that every voice can be heard.

Fear...it has had enough control!  It is time to be brave!

Celebrating an Accomplishment

By Chantel Haynes MSN, APRN

I started my degree program in March 2021… Through severe Covid (4 weeks on oxygen) and a couple of retaken courses, a shockingly sudden career change, loss of both of my initial clinical sites, and then traveling away from home 12-15 days a month for the past year meanwhile working while I was home, and then traveling to Pennsylvania to finish my births…..

It is official, I can apply for graduation and the opportunity to take my APRN (advanced practice nurse practitioner) boards.

When I am done I will be a Certified Nurse Midwife (CNM), a medical provider caring for women of all ages from birth to death, and caring for them during pregnancy, birth and postpartum, and newborns to 6 weeks old in a multitude of settings.

I could only have accomplished this with the love of God and the care of my Savior who placed those I needed in my path, gave me a family who loves and supports me wholly, and friends to lean on and learn from. It’s amazing what mountains were moved.

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Snapshots

I was thinking the other day about who we are to others, who we appear to be at this moment in time, and what is missing from the impressions we leave behind. This is why those “I have not done” lists on social media are so popular. We want to know a person’s story and who they were before who they have become. These lists are like the pictures of the 80-year-old woman standing in front of the mirror, and in her reflection, you see a nurse, a lawyer, a soldier…or a child. Snapshots miss so much about what made us who we are today, and they completely disregard the changes we have made in our lives. Most of all, they miss our growth and the lessons we learned within that change. The danger is that we dismiss the person’s past and expect what we see, often leading to less grace, less humanity, and less forgiveness.

“Then ask yourself why it is necessary to know why someone is the way they are, or what in their past taints their now, for you to give them the understanding and grace you would readily give if you met them in that past moment.”

My snapshot may look like this – Wife, Mother, Grandmother, Nurse, Student, Midwife, Woman of Faith, Lover of sunflowers. Where I have been has made me who I am, but you cannot understand ME without knowing my past or experiences. If I look in the mirror, I see a young girl with horribly low self-esteem with an extreme overbite, one too many bad haircuts, and years of bullying by both peers and adults. I feel the times of intense poverty and instability as a daughter of a diabetic blind father and a bipolar mother. I survived sexual assault and physical abuse and was kicked out of my house at 17*. These experiences were wrapped into a neurodivergent brain that said what it was thinking, did not understand social cues, and desperately wanted to be included and loved.

*My children know I am a survivor of childhood abuse, domestic violence, and sexual assault. These have never been in-depth conversations and usually come about through topics such as autonomy, protecting self, how we treat others, and why I or others are the way we are. Many things have gone unsaid, and I have told my children that if they read my journals, they should do so with caution, and certainly after I have left this world because there are things they may not know. I think that is likely true for all parents, as we tend to guard our children from our past.

It is a protective instinct to shy away from sharing our past with others, especially our children. Sometimes, we are ashamed of our choices, or it is painful and difficult to talk about. We may believe that sharing our past gives our children permission to act the way we acted, and we do not want them to make the same mistakes we made, or we may believe that our past is behind us and does not impact our current selves. We may have come from a household where you didn’t talk about self, struggles, behaviors, or events and feel that speaking these truths is taboo. This may lead us to normalize negative behavior, leading to generational trauma as harmful practices are passed down from parent to child. In most cases, our children do not understand where these beliefs or behaviors stem from, and they may normalize the negative as they mirror our behaviors.

This is where I remind you that you are not responsible for the choices of others, especially when you were a child or the outcomes of those choices. It is not your responsibility to carry the weight of those decisions; doing so harms you and your future self. While you are responsible for your own actions and reactions, it is limited to what you knew at that time. If you, as a child, were given alcohol or drugs by an adult and became an addict, you are only responsible for what you did when it was solely your choice. If once you were responsible for yourself, you continued to use it, then that is where your responsibility starts. There are still consequences for your behaviors as a child; sadly, those consequences may carry through your life and into other’s lives. This is especially true in cases such as a child giving another child drugs, or a child sexually abusing another child. We must learn to forgive ourselves and let go of the psychological and emotional weight brought by another’s choice. Carrying this weight prevents us from healing and prevents that person from being held responsible. If you were standing in front of me, I would physically lift that invisible weight off of your shoulders, and we would symbolically place that weight on the person responsible. It is theirs to carry, not yours.

If you have known me for any period of time you have heard me say, “When you know better, you do better”. I often talk about the discussions I have had with my (now adult) children about their childhood and their perceptions. My husband and I have prompted our children to take what was positive from childhood into adulthood and leave the negative. We are honest that we made mistakes, sometimes that caused emotional and psychological harm, and we want our children to know that they can always talk to us about those mistakes. My fondest wish is to roadblock any passed down/generational trauma and forge the way for permanent change for future generations of my family.

Take what I told you above about my childhood, and think of a moment when you have judged another by their snapshot. If you knew more, would you have reacted differently to that moment?

Ask yourself why it is necessary to know why someone is the way they are and what in their past taints their now for you to give them the understanding and grace you would readily give if you met them in that past moment.

Snapshots are only one moment in the making of a lifetime.

Everything Has Risks

I am a fierce supporter of informed choice and autonomy in healthcare. I have worked for 23 years to give my clients and patients the freedom to choose what they feel is best for them. That means carefully educating to avoid bias, coercion, intimidation, or the appearance of authority.

“Every choice we have made leading up to that moment has created outcomes that pertain only to us and only to that moment.“

Informed choice involves the review of the risks and benefits of options and is not solely a medical treatment issue. It often impacts the choices we make in our daily lives that have little to do with healthcare. Additionally, the choices we have made before this point, especially the choices we have made with our bodies, and our lifestyle, impact our options and the risks of those options.

This is the risk-benefit ratio. These are the options and choices where you have to consider the risks versus the benefits and is highly individualized. My risks and benefits pertain to my circumstances and center around previous choices and outcomes. This is the reason why routine care policies and standard practices can be harmful. Every choice we have made leading up to that moment has created outcomes that pertain only to us and only to that moment. It is our risk-benefit ratio, and no one has the right to tell us what risks are too much, and what benefits are too few or vice versa.

I have had clients/patients who want their nurse or provider to make their care decisions. In those cases I take that responsibility very seriously and try to consider the risks and benefits within their treatment. I then introduce options with the least risk first, ask their preference, and continue to involve them in their care as much as they desire. I never want to be responsible for making decisions for a human who can choose for themselves. Even as a parent, the “because I said so” was very rare, and there were almost always two choices and an explanation of why. I’m not going to let you run into the street and get hit by a car or grab a hot pan, but if you try to do those things, we will talk about the risks.

“We don’t get to choose the risks or consequences, as they are a part of the natural order of humanity.“

The fact is, everything has risks, even those choices that do the most good or have the highest reward, we perceived the benefit so greatly outweighs the risks that we do not consider there to be negatives. We don’t get to choose the risks or consequences, as they are a part of the natural order of humanity, and even when we only see the benefits or positives of our choice, there will be a negative aspect.

“My risks and benefits pertain to my circumstances and center around previous choices and outcomes. “

For those that do not want children, either temporarily or permanently, the risk of pregnancy is so high that they will do everything to prevent it. They accept the risk of their decisions, namely birth control or surgery, because the risk of a pregnancy is much higher. For those who want children, they view pregnancy as a positive without risk, or the benefits so greatly overshadow the risks they are minimized to the point of null. However, the risks still exist, and usually show up to be dealt with; such nausea and vomiting, fatigue, stretch marks, bone and joint aches, and ultimately birth.

“However, the choice is ultimately ours, and no one has the right to remove our ability to choose which risks and benefits are acceptable to the individual.“

When we generalize healthcare and create an environment where everyone has the same interventions, we take away informed choice and force negative impacts creating a high risk, low benefit care environment. This is especially true with “you will” interventions – and often these are presented as you will have or we will be doing this intervention, and the options are often timed. For example: at 20 weeks you will have an ultrasound – at 37 weeks you will have a GBS (beta-strep) swab – we will break your water at 3 pm. These are suggested as interventions without risk, or where the benefit is assumed and the risk minimized, yet no one but us can assess the risks and benefits, and there lies the problem. For me, the option presented may carry acceptable risks, but for you the risks may outweigh the benefits and carry more harm.

“Additionally, the choices we have made before this point, especially the choices we have made with our bodies, and our lifestyle, impact our options and the risks of those options.“

I live the consequences of my choices. Yes, some of those choices impact others around me, and that should be considered in the assessment of risks and benefits. However, the choice is ultimately ours, and no one has the right to remove our ability to choose which risks and benefits are acceptable to the individual. As patients we have the right and responsibility to question, investigate, research, and expect feedback regarding our options. As providers we have to acknowledge that we do not fully know the risks or benefits for our patients, and since we do not live their life, we have to defer to their personal assessment. This means taking the time to listen and educate without the bias or our belief system or personal experiences.

*Sometime the options available are outside of the providers skills or ethical beliefs. The solution is referring or deferring to a different provider that can meet your patient’s needs.*

Addiction and Law

I wrote this in response to a new law my city has passed. It targets those with drug paraphernalia through city (municipal) law, and is touted to make criminalization and incarceration easier and quicker.

No one wakes up one morning and says to themselves, “Today, I am going to choose addiction, homelessness, PTSD, suicidal thoughts, or be abused.”

I am writing regarding the new municipal Fentanyl ordinance. I have been an RN for 14 years, working bedside in a hospital for the majority of that time and the past 2 years as an opioid treatment nurse at a substance abuse clinic. Before becoming an OTP nurse, I had worked with hundreds of patients with addiction disease. However, my time at the clinic has added vital interactions that have helped clarify the picture of addiction and its impact on the community.

This new municipal law is a “looks good from the outside” type of law. We can now arrest, charge, and jail a person who is in possession of drug paraphernalia, and we can do it faster than state and federal law enforcement because the law is municipal (city) based. Per the city prosecutor, this means we will be removing drug dealers off the street immediately after arrest. It sounds pretty, doesn’t it?

So, what is the negative of this new law? Simply put, drug dealers rarely carry drug paraphernalia, and what they are doing, selling illicit/illegal chemicals, is already covered by multiple state and federal laws. I am a child of the 80s and had children during the DARE school efforts. That is 40 years of actions and laws made to remove drugs from our streets that have been ineffective. We are living in the worst addiction history of our time, and nothing written into law has stopped drugs from infiltrating our streets and families.

However, generational trauma is like the story of The Princess and the Pea, where layer after layer is placed over that pearl of goodness and peace until it can no longer be felt, and all we see is the trauma.

Laws do not stop drugs, and they certainly do not stop, cure, or remove addiction from our society. Only the people in the community can do that. The person being arrested by this new shiny law is not the dealer but the chronic addict suffering a disease that has ravaged our society for decades. It is another law of words in a war that is fighting against the wrong target. Society loves to expect responsibility for self. We say, “Well, you are an adult now, and you make your own choices,” in a one-dimensional universe, that is right. If the abused could only wipe away the hurt and trauma at age 18 and suddenly become an emotionally healthy adult who has the right choices in front of them, we could all be satisfied that our self-righteousness is successful. However, generational trauma is like the story of The Princess and the Pea, where layer after layer is placed over that pearl of goodness and peace until it can no longer be felt, and all we see is the trauma. No one wakes up one morning and says to themselves, “Today, I am going to choose addiction, homelessness, PTSD, suicidal thoughts, or be abused.”

The pain is there and must be processed, faced, explored, and healed the best it can be healed. Only then do we free ourselves from the chains others put around us. Unfortunately, the cycle is ferocious, and once those chains wrap around us, we tend to make decisions that tighten those chains.

Few turn to drug abuse who themselves have not suffered abuse. Yes, there are instances where a mentally and physically healthy person becomes addicted to a substance, but they are rare. The majority have lived through a life affected by mental, physical, sexual, and/or psychological abuse. Some are given their first drug by their mother/father/brother/sister/uncle. Most sought out and found a way to numb their physical, emotional, and psychological pain in an attempt to function within society. Sadly, because we as citizens would rather ignore and then criminalize, the pain and abuse may have been passed down, creating layers of generational trauma that the child (now adult) is forced to weed through. As a nurse, I have heard personal and family history that would make your nightmares seem like happily ever after dreams. A person can not process these abuses and come out unscarred. Unfortunately, that is not the way our minds work.

The choices of those who make decisions for us while we are children impact us for the rest of our lives. As a society, we cannot escape the poor and even detrimental actions of the adults who care for children. The pain is there and must be processed, faced, explored, and healed the best it can be healed. Only then do we free ourselves from the chains others put around us. Unfortunately, the cycle is ferocious, and once those chains wrap around us, we tend to make decisions that tighten those chains. A person who is healing from childhood trauma often makes adult decisions that cause more trauma – hence the creation of generational trauma.

Laws criminalizing drug use do not work! Supporting the programs that help break those chains, give us hope, and bring light to the trauma-causing behaviors of those around us is an absolute necessity. We know without a doubt that addiction recovery takes therapy and time. We know that people will relapse as they work through both the experienced trauma and the trauma of their own choices. We know they do not want to be an addict, but the desire to numb overcomes everything else until the drug is all they know. For many, a combination of medications, therapy, and support leads to remission. Just like any chronic disease, addiction is never cured, but it can be stunted and remitted so that the person can live as complete of a life as possible as they recover from what they and others have done to their body and self.

If laws do not work, then what is our recourse? We must care, be willing to act, and refuse to accept the continuation of trauma in our lives. We must be brave enough to stand up for those who can’t defend themselves and stand up for ourselves and future generations to prevent the trauma from being passed on. We must see the person trying to heal and give them the grace and support to change their lives. We must be willing to look past the drug to the person and support the people and programs that can help them. We must see the bravery and strength that it takes to build the boundaries that prevent our children and grandchildren from becoming victims of the generational trauma that chains so many. We must support chain breakers and show compassion as they fight to heal. Most importantly, we must recognize that for people with an addiction, the handcuffs, jail cells, and prisons do not heal and do not cure…and they rarely create a better person or a better life.

Link to my old Doula site, just for fun

http://www.sunbuddiesdoula.bizhosting.com/

Remember That Catastrophe…

Plainly said, hospitals as they are currently run are unsafe for patients.

You feel a twinge of pain in your back on the right side, and you wonder should I go see the provider, but you talk yourself out of going.

Three days later you feel sick, have a fever, and you have pain when you urinate. Now you have to go see the provider, who promptly sends you to the emergency room to rule out a kidney infection (pylonephritis).

You are triaged at the emergency room and then asked to take a seat. You wait 1….2…..3 hours. People rush past you, bleeding, unconscious, screaming children, trauma patients, and you wait. At 3 hours you ask how much longer, as your pain is worse and you feel dizzy. You are told they only have enough staff to use 3 out of 8 patient rooms, and you will be brought back when they have an open room. So you wait, 4…. 5…. 6 hours.

In a place you are supposed to get better, you are getting worse.

Finally, they call your name. You are assessed by a nurse, labs are taken, an IV is started and you are given IV fluids while you wait to see the ER provider. After 2 more hours in walks a provider who says they are admitting you for a kidney infection.

45 minutes later you are wheeled into a Med-Surg room, helped onto a bed and you wait… A nurse comes in, takes your vitals, says they will be right back. An hour later you push your call light because the pain is getting worse. Unbearable pain along with fear that you will be left helpless takes hold. In a place you are supposed to get better, you are getting worse. Staff flutter by with barely a moment to spare.

Billable patient care not the patient is the priority for the system.

– Speaking of staff: hospital staff, especially nurses, work in such a toxic environment that every moment is under intense pressure to get done what can’t be done. There is little time to care for their patients needs, and no time to care for their own needs. It is common for a nurse to not have meal or bathroom breaks through a 12-14 hour shift. For many sitting, hydration and snacks occur while charting the mandatory documentation. Up to 60% of new nurses leave the nursing profession within 1 year. Hospital administrators and the systems they work in focus so completely on their income they have cut support staff, increased nurse to patient ratios, shorted patient care supplies, and refused adequate pay; yet their salary has continued to increase, sometimes drastically, while they decry lack of funding. To that fact, it should be stated clearly that nurses are NOT a chargeable cost. At no time have insurance companies or administrators suggested billing for hospital nursing care. Your nursing care is wrapped up in your room cost. Nurses are not a credit to the hospital monetary system, they are a cost, and are treated as such. Yet, hospitals cannot function without nursing care for patients. Billable patient care not the patient is the priority for the system.

As a patient, you lay in your hospital bed, alone with only the call light as your connection to your helpers. That call light often gets answered remotely, or not at all. In some facilities a telenurse on a screen asks you what your need is. Your medications will be late, your mobility will be limited, and your pain uncontrolled, because there are too many patients and not enough staff. The most critical patients will get what little time the staff has. This is the experience that many hospital patients are having. This environment is harming our patients, and causing unnecessary injuries and deaths. Plainly said, hospitals as they are currently run are unsafe for patients.

How Happy Found Me: AKA The Baggage We Carry

Yesterday I was on my way to work and listening to Klove when they asked, “What is one word you would use to describe your life right now?”
Immediately the word “happy” entered my mind.

Happy is scary for me.

Happy is a place of vulnerability.

Happy often turns to sad.

Happy gives me anxiety.

For years I didn’t let happy in.

I settled in a place of satisfaction with my life and dedication to my family. I vowed to break the cycles of abuse in my family and be a better mother and wife. But, I didn’t allow happy in.

Many people in my younger life were a source of instability, either because of my mother’s actions, who lived with bipolar disease, or distance as we or they moved. Due to my mother’s instability, my father’s illness, and intense poverty, I was pushed out of my home at 18. This led to marriage at 18, the birth of my first child at 19, and divorce after intense domestic violence. Additionally, like many, I am a survivor of sexual assault as a child and as an adult.

If you don’t expect happy then you can’t be disappointed by sad

At age 24, my father-in-law passed away suddenly. This thrust me into the world of a mother-in-law who, as of 31 years of marriage, refuses to have a relationship with her first daughter-in-law (me), instead maintaining a grudging distance. *For Christmas one year, she gave me a scrub brush. It was a nice scrub brush, but… That is a story for another time* This left me feeling uncomfortable and unwelcome, often alone. I knew my husband deserved a relationship with his mother and siblings, and our children deserved a relationship with their grandmother, aunt, and uncles. This led to years of emotional distress as I tried to fit in and “earn” her love. Then at age 27, my father passed away after years of struggle with juvenile diabetes, blindness, and 6 years of hemodialysis. My dysfunctional relationship with my mother became unsustainable within a few weeks after his death. Eventually, I realized that my dad was the glue holding my relationship with my mother. Without that buffer, our relationship was all toxic and had no benefit.

A child living with abuse, trauma, or a parent with a chronic illness, mental illness, or addiction normalizes their experience.

I read the paragraphs above, and my nurse brain sees why someone experiencing those life events might push happy away. However, I also understand that I lived as if everyone’s life was like mine for much of my youth, which was as good as it would be. That is what children do. I was blessed that along this path, I had helpers: grandparents who did their best to love my sister and me, an aunt who loved me and attempted to protect me the best she could, and an ‘adopted’ mom and family (I briefly dated her son) who offered me kindness, gentleness and showed me the love of God through her actions. I met, married, and grew up with an amazing man by my side who has worked hard to be patient with my baggage.

Happy. That emotion I thought I had given up on has finally found me, and it only took me 51 years to let it in. Why now?

I’m sure there are some happy memories stored under the pain, but I have to dig through the pain to find them.

Recently, my daughter asked me to tell her happy memories from my childhood, and we quickly realized that I don’t have many, or, more correctly, I don’t have access to many from my childhood. I can access stories of hardship, poverty, emotional pain, and a lack of happiness. I can also find memories of my dad that I am fond of, and they make me smile, and I tell them to help my children know him. I find memories with feelings of safety when my sister and I spent time with my grandparents and aunt. Honestly, I have a more challenging time finding memories of my mother that elicit feelings I want to share with others. That is hard for my child’s heart to understand; however, I know that nothing I did caused that pain, and it is NOT mine to hold on to. So, I let that be.

Breaking the cycle means letting the bad be. Laying the sad aside. Allowing myself the grace to know that nothing I did as a child caused the poverty, trauma, emotional and physical pain, loneliness, and feelings of not belonging. Seeing the heartache without owning it. Learning not to carry it with me. Learning to look at the pain without allowing it back into my life. To break the cycle, I had to learn to unload the pain I carried in my baggage to make room for happy.

The truth is, happy couldn’t find me until I let go of unhappy

We have Catasrophic Failure

We are in trouble!

There is no other way to put that. We are at a tipping point that this country and our medical system have NEVER faced before.

We have glimpsed this gateway before…..a couple of months of overtime, chronic short staffing and staffing cuts that create unfillable holes, patients spending hours or days in the Emergency Room waiting for a bed, nurses and providers spent to their last step, shortages of supplies and medications…..We saw moments of this before Covid.
We have now walked through thE gateway and are living that reality.

What the average person sees:

Staffing Shortages	Not Enough Beds	Limited Time with Provider/Staff	Supply Shortages
staff apologizing for late medicines, dietary mistakes, late medications, missed hygiene, phone calls and call lights that go off without answer	patients waiting in the waiting room or emergency room, being moved to a different unit or a different room, being discharged early for patient census, being sent home and asked to follow up with your provider instead of admitted	Nursing only at your bedside for medication administration and assessment, having multiple persons answer your calls, doctor visits later in the day, staffing apologizing for limited access, missing your respiratory treatment	Being told we are out of a product, a medication, and multiple other supplies

What you do not see:

Staffing Shortage	Not Enough Beds	Limited Time with Provider/Staff	Supply Shortages
The unit manager working the floor for the 4th shift straight, patient care coordinators as nurses caring for patients, multiple staff from travel agencies to fill staffing holes, staff working 1-2 extra 12-hour shifts a week, 7 patients to 1 nurse staffing ratio, missed breaks-meals, staff working in multiple departments to help out. Staff working while their own health declines.	Providers and nursing caring for high number of patients so that patients can stay in their community, admin meeting to find ways to care for more patients, being asked to work in other departments to ease their burden, sending patients home as soon as they are able to open another bed.	Staff that haven’t had time to eat-use the bathroom or chart staying late, Providers admitting/discharging patients, assessing patients, ordering medications and treatments, charting assessments and mandated documentation, talking with families, researching treatment options, calling other specialists, CALLING hospital after hospital trying to transfer a critical patient. Nurses putting on and taking off gowns/masks/gloves to go into each room, answering call lights, giving medications at prescribed times, bathing patients, bringing food and feeding patients, charting assessments, admitting and discharging patients, conferencing with providers, calling families, giving oxygen, performing cpr, catching babies, holding hands, and doing their best to care for their patients	The anxiety, tears, frustration, prayers and anger when a patient needs a medication, supplies, treatments, and resources that ARE NOT available.

I was that patient. It was painful to hear my coworkers struggle to care for patients, knowing I had increased their burden. I knew first-hand what was going on outside my door. The sounds of hurried feet, the deep breaths before entering a room, the sadness of loss, the desire for your shift to end and, your burden to be taken by the next shift.

Let’s talk a minute about anxiety, frustration, and anger…let’s talk about the tears and the near panic. The fear that we are not enough, can not do enough, do not have enough to take care of our patients. The absolute fatigue and mental exhaustion of caring for patients in an environment that isn’t enough. The choices that must be made to give the most critical patients your all and, hope that you have something left for everyone else.

Let’s talk about the sleeplessness of waking up thinking about what you didn’t do, couldn’t do, and running events over and over in your head trying to find a way to do better. The emotional turmoil of wishing things were different but knowing there is little you can do to change this. The moments of distress as you watch a patient die and their family experience loss.
Nurses hold space. We do what we can to take care of each other. If a provider sits for a moment, we do our best to let them be, and we wish a moment of peace on them. We do our best to be pleasant, smile, tell our patients we aren’t too busy for them and, help calm their anxiety and fears. Holding space is emotionally and psychologically taxing, and some have little left to give. Yet, we hold space……so you can heal, say hello or goodbye to a loved one, give hope, and seek peace when hope turns to finality.

It has been two years of Covid. Two years of coming home to our families tired, sad, depressed, anxious, frustrated, angry….our friends and family have done their best to care for us. But, it has been two years.

And even though we are tired, we will press on. We will be here for you!

SLIDE SHOW

This is for you my friends.

Part 2 Covid for Me

If Covid has taught us anything, it should be to love others, be an active participant in your life, and not procrastinate living.

In the course of caring for patients, many nurses have contracted Covid. It is an inherent risk of the personal patient care setting. We reach toward and push aside caution to ensure that our patients and their families have the best that we can give. From the very beginning of Covid, each one of us knew the risk. August 2021 was my turn.

On a Friday in August, Covid snuck itself into my body. The following Tuesday came the realization that after 20 months of working with Covid patients, I was now a Covid patient. I have comorbidities that put me in a higher risk category. I do not regret my choices nor my sacrifice. All we have is the care we give to others and the sacrifices we make to better the lives of those around us. My faith is strong, and my support system is on a firm foundation.

I didn’t feel great, but I didn’t feel horrible. I admit to a false sense of security that my Covid was a mild case, and like I have done my whole life, I continued to care for my family and my responsibilities.
The following Sunday, I noticed a change. I felt worse, and my cough was a little wetter, my fatigue more impairing. We knew I needed to be seen by Monday, so we took our first trip to the ER. Labs, chest x-ray, IV fluids, breathing treatments were administered, and we all felt comfortable for my return home.
Unfortunately, we still have an incomplete picture of how Covid attacks the body. After months of caring for Covid patients and now after having it myself, I believe that Covid attacks the central nervous system as it causes generalized inflammation in the body. While all tests indicated I was holding my own, my body wasn’t so confident. As I became sicker I lost track of time at home, as my appetite dwindled, I became more lethargic, forgetting to hydrate. My time became a heavy blanket that dragged me down, making every effort feel like I was wading through the ocean. By Wednesday, we knew we had to return to the ER. Once again, Vern dropped me off at the doors and waited in the parking lot while tests were performed. This time it was clear that the inflammation was overcoming my lung’s ability to function.

Covid pneumonia covers the inside of the lungs with a spiderweb of infiltrates, causing tightness and pain when breathing. As a result, it becomes difficult for your body to oxygenate, and your oxygen saturation levels drop. If not caught and treated quickly, the body starts to experience failure. There are specific lab values that we identify as markers for severe covid disease. Ferritin and LDH levels spike, liver enzymes indicate acute liver damage, severe dehydration and hypoxia set in, and the heart bears the stress of circulatory collapse. In turn, pain increases, appetite diminishes, and lethargy is so complete that even drinking fluids is too much. This is about the time that the emotional and psychological despair sets in, and you begin to contemplate what the future holds. It isn’t a good headspace, and for those who are severely ill, on high-flow, have dealt with long-term chronic illness, being secluded in their room without the support of friends and family, the will to live can start to slip away.

I was admitted to Med-Surg on low-flow oxygen, and we started to work on getting me through the next few days. We threw every treatment we had at Covid. I can’t speak highly enough about my coworkers and friends; they are amazing at their jobs and wonderfully caring. Even though I was in isolation, I was being checked on and cared for. Day 3 was the hardest, and I spent quite a bit of that day in tears feeling alone and sad. I felt loneliness, despair, and immense sadness.

My hospitalization lasted 4 days. On the 4th day, we decided that it would be better for my mental health to be home with my family. I was still on oxygen, but we could set up resources, and I went home.
Going home didn’t fix things. I was still sick, still weak, and my family was still battling Covid. It would be 15 days of oxygen, a cardiac echo, doctor’s appointments, chest x-ray, CT scan, and lung function testing. Others have had their own journey that has taken longer, or was more severe.

I’m happy to say we have all recovered. You could say I was blessed or lucky; however, I have worked diligently using nutrition, homeopathy, herbs, and essential oils to both prevent illness and give my body the tools to fight infection should it occur. I utilized my resources and went for help when I worsened. I didn’t wait because I knew waiting increases severity and the risk of intubation and death. As I told my friends and family, Covid was not winning this fight! Do not doubt that I know things could have been different. There is no guarantee in this life.

This post is dedicated to those fighting disease and those that support them. No matter what we do in life, disease finds us. Illness occurs. Covid is just one of hundreds of diseases that change our lives. No one is exempt. I do not know why some are cured, and others are not. Nor do I understand why some live and some die. What I do know is that no matter the challenge we face, those who love us help us carry our burdens and help bring us peace and joy. I can’t thank those special people in our lives enough. They are truly angels!!!!

Part 1 Being a Nurse During Covid

*Disclaimer: I will not waiver that personal autonomy and informed choice is a human right. No one has the right to coerce, threaten, mandate, or legalize away the right of each of us to choose our risk. I do not have to agree with your choices to support the right to determine what risks and benefits are acceptable in your decision-making.

There are many activities that humans participate in where they have chosen their comfort with risk, yet other humans find those activities too risky. I have no desire to skydive, swim with sharks, free climb a cliff, ride a motorcycle, race a car, use tobacco, use marijuana, etc. For me, those carry too much risk. However, I had several children; I became a nurse, stopped for and ran toward accidents, broke up fights, and defended a victim, putting my safety at risk. Personal risk evaluation is just that, personal. No one can tell you what risk ratio is appropriate for you.

The hospital is a hard place to be for staff and patients right now. We have lived in a constant state of stress and anxiety. Restrictions in the name of Covid and safety have removed support from friends and family that often grounds us and helps us feel safe when we are sick. We have forsaken therapeutic touch and empathy for patient isolation and PPE, setting restrictions and limitations where people need humanity. The fear and politics of Covid have created a system of isolation so complete that some patients would rather go home to die than sit behind a closed door fighting to breathe. The very thought of being isolated from friends and loved ones is so debilitating that patients refuse medical help or leave AMA to continue to have access to that support system.

Nurses are used to working around hospital politics and red tape while advocating for their patients. The current environment goes beyond these limitations and creates daily moral and ethical challenges that drain us emotionally and psychologically. Every shift comes with the knowledge that we are short-staffed and do not have the resources to care for our patients the way they need us to care for them.

I know some amazing nurses, and yet no superpower on earth can make time slow or create resources out of air. While doing our best is not enough, it is all we have to give, and we have given our all every shift for the past year and a half. We are required to stretch ourselves beyond the stretchable in the name of sacrifice. What started in March 2020 has turned into a constant draw of energy that has brought us to our surge capacity both emotionally and psychologically.

Interestingly one of the arguments for our continued sacrifice comes from the choice to become a nurse, as if obtaining a nursing degree automatically makes one a permanent martyr for the sake of the medical system’s greater good. I don’t know about you, but no nurse on this planet could have foreseen Covid when they chose nursing for their degree. The very fact that choosing nursing as a profession equates to sacrifice of ones mental and physical health highlights why nurses are leaving bedside critical care and choosing travel and contract nursing. AT some point, we have to take our advice and focus on our physical, emotional, psychological, and familial health.

Polycystic Ovarian Syndrome/Disease

I wrote this paper several years ago, and sadly as I review current PCOS treatments I find not much has changed. We are still utilizing many of the same medications and focusing on fertility and symptoms. In fact, over 13 years later and nothing has changed. In healthcare, women are still second-class citizens and sit behind in medical advances.

For more information visit

www.mayoclinic.org/diseases-conditions/pcos/diagnosis-treatment/drc-20353443

And

www.pcosaa.org

Introduction

Polycystic Ovarian Syndrome is a lifetime health issue that affects only women. Initially, it was connected to infertility; however, scientists now know that the effects of Polycystic range from puberty to death. Polycystic is currently considered an endocrine disorder and not just an infertility issue.

What is PCOS?

Barber (2006) states, “Polycystic Ovarian Syndrome (PCOS) is a heterogeneous (women only) condition that affects approximately 6-10% of U.S. women and is associated with metabolic syndrome, which very often coexists with an overweight or obesity health issue.” PCOS seems to come in two forms, hormone-resistant and insulin-resistant. While the results seem to be the same and are treated similarly, each has different symptoms initially. PCOS usually manifests itself when a young woman gets her first period or after her first pregnancy.

In women with hormone-resistant PCOS, the ovaries do not make enough hormones to mature the waiting egg for ovulation. Instead, the egg accumulates fluid, and a cyst forms, ovulation does not occur, and the body does not produce the hormone progesterone. The primary symptom is anovulation in these women, or a menstrual cycle spanning greater than 45 days. The lack of ovulation and the lack of progesterone creates infertility, which creates an imbalance in the endocrine system, leading to further hormone imbalance and eventually insulin resistance.

In women who have insulin-resistant PCOS, the body does not respond to insulin. To combat this, the body creates an excess amount of insulin, dropping blood sugar levels. Insulin balance is essential to hormone balance and production, leading to carbohydrate craving as the body attempts to balance the low blood sugar levels. As the blood sugar level comes up, the insulin level again rises. A vicious cycle of high caloric intake, weight gain, and eventually hormone resistance and infertility. Barber (2006) says, “The presence of insulin resistance in women with PCOS (largely reflecting impaired glucose disposal in skeletal muscle) was established initially in 1980 by Burghen et al….There is some controversy regarding the presence of insulin resistance in lean women with PCOS. Possible reasons for this controversy include the use of variable definitions of PCOS and differences in ethnicity, family history of type 2 diabetes and personal history of gestational diabetes in women with PCOS and controls between studies.”

Symptoms of PCOS

Polycystic is a complex syndrome. The symptoms are often variable, broad-based, and similar to other syndromes and disorders, making PCOS intricate and sometimes difficult to pinpoint. The list of symptoms is hugely generalized, and many symptoms are directly connected to obesity.

Durso (2004) states that women with PCOS often have many of the following symptoms:

~ anovulation (absence of ovulation) or infrequent menstruation with heavy periods. *Note menstruation may occur in the absence of ovulation.

~ infertility because of anovulation

~ Hirsutism on the face, chest, stomach, back, thumbs, and toes

~Acne, oily skin, or dandruff

~ Balding, voice deepening, increased muscle mass, decreased breast size due to the overproduction of testosterone.

~ Abnormal weight gain or obesity

~ Type 2 diabetes

~ High cholesterol

~ High blood pressure

~ Thickened dark brown or black skin on neck, arms, breasts, or thighs

~ Skin tags in armpits and neck areas

~ Sleep apnea or excessive snoring

Diagnostic Tests

The process of diagnosing PCOS is complicated and depends on the level of understanding and knowledge of Polycystic by the primary care provider and the technology available in the patient’s area. Because the field of symptoms varies so greatly, testing should be comprehensive as well.

Tests that are conducted to confirm or rule out the presence of PCOS are:

~ Thorough medical history should include the age of the first period, length of time between periods, and quantity of flow in teens.

~ Physical examination including Body Mass Index and checking for excessive body hair, signs of Acne, loss of hair (balding).

~ Pelvic ultrasound including level 2 doppler color imaging of ovaries.

~ Comprehensive hormone panel blood workup including a pregnancy test, testosterone levels, DHEA-S levels, androstenedione levels, prolactin levels, thyroid levels, and 17-OHP levels.

~ Fasting glucose tolerance test or comparable insulin/glucose blood level test.

Treatment

The treatment options for Polycystic in the past have primarily depended on both symptoms and desired results. Until recently, the assumption of PCOS as a fertility problem lead to treatment by combined oral contraceptives. Snyder (2005) states, “For many years, oral contraceptive pills have been the mainstay of therapy for women with PCOS not desiring pregnancy. The best choices are the combined oral contraceptives (COSs). This hormonal therapy can regulate grossly irregular cycles, as well as decrease testosterone, thus decreasing the occurrence of Acne and Hirsutism.”

However, scientists now understand that uncontrolled PCOS can have lifetime health effects, and therefore treatment options have expanded to include hormonal, insulin, and weight treatments. Treatments currently available include:

Insulin regulating medications such as Metformin (Glucophage), used in patients with type 2 diabetes and those with insulin-resistant PCOS, is given to regulate insulin levels, decrease testosterone production, slow abnormal hair growth, and initiate ovulation. Many women who use Metformin for PCOS conceive within 2-6 months and use an insulin-regulating medication prior to conception and during the first months of pregnancy and may reduce the risk of gestational diabetes.

Although not the recommended first course of treatment, ovarian drilling surgery is available and can induce ovulation if the goal is pregnancy and not a PCOS treatment. While increasing the chance of conception, this surgery carries those risks associated with major surgery and is only suitable for one treatment cycle.

There are medications used to treat the symptoms of Polycystic such as Vaniqa, which slows hair growth, or Aldactone to treat hypertension and decrease free circulation testosterone levels. However, Snyder (2005) points out that “Currently, there are no FDA approved medications indicated for the treatment of PCOS. Any drug that is used in clinical practice is used off label.”

Currently, the most popular treatment for Polycystic is lifestyle changes and weight loss. Barber (2006) states that “Even modest weight loss of 5% of body weight has been shown to result in significant improvements in both symptoms of hyperandrogenism and ovulatory function in women with PCOS. There is no doubt, therefore, that adiposity plays a crucial role in the development and maintenance of PCOS and strongly influences the severity of both its clinical and endocrine features in many women with the condition.”

Without treatment, women are at risk for serious health problems. (NICHD 2004) states, “Women with PCOS can be at an increased risk for developing seral other conditions. Irregular menstrual periods and the absence of ovulation cause women to produce the hormone estrogen but not the hormone progesterone. Without progesterone, which causes the endometrium to shed each month as a menstrual period, the endometrium becomes thick, which can cause heavy bleeding or irregular bleeding. Eventually, this can lead to endometrial hyperplasia or cancer. Women with PCOS are also at higher risk for diabetes, high cholesterol, high blood pressure, and heart disease.”

Conclusion

Scientists now know that Polycystic Ovarian Syndrome is no longer just a fertility issue but a lifetime health issue for women. The consequences of ignoring this disease are severe and life-threatening. Because acknowledgment of PCOS as a health issue is relatively recent, many women have gone untreated and are now dealing with the long-term health effects of this disease. Women who suspect PCOS in their family or who are experiencing any of the symptoms of Polycystic should seek out a provider who is knowledgeable about the syndrome and its health risks to obtain current and comprehensive treatment.

Reference:

Barber, Dr. T. (2006). Obesity and Polycystic Ovary Syndrome. Clinical Endocrinology, 2006;65(2):137-145. Retrieved October 2006, from http://www.medscape.com

Durso, Nancy (M.D.). (2004). What is Polycystic Ovarian Syndrome (PCOS)? Retrieved October 2006, from http://www.4woman.gov/faq/pcos.htm#3

Kusku, Naci K. (MD), & Koyuncu, Faik M. (MD). (2002). Insulin and Oral Antidiabetic Agents for Treatment of Polycystic Ovary Syndrome. Medscape General Medicine, 4(4). Retrieved October 2006 from http://www.medscape.com/viewarticle/440584_1

Legro, Richard S. (M.D.). Diagnostic Criteria in Polycystic Ovary Syndrome. Seminars in Reproductive Medicine, Med 21(3):267-275, 2003. Retrieved October 2006, from http://www.medscape.com

Snyder, Barbara S. (2005). Polycystic Ovary Syndrome (PCOS) in the Adolescent Patient: Recommendations for Practice. Pediatric Nursing, 2005;31(5):416-421. Retrieved October 2006 from http://www.medscape.com

Lack of Family Intimacy and Its Effect on the Children

During my time as an elementary school art teacher, I can remember my shock the first time a child I hardly knew threw her arms around me in a tight embrace and exclaimed her love for me. Holding this tiny girl, I stood there and wondered why she would pick a stranger to show such affection to. Over the years, this scenario has played out a hundred times, and each time I reciprocate the embrace and assure the child that they are cared for; and each time, my heart breaks just a bit. It took me some time to understand that children like this are parched for parental intimacy and that it is not me but my smile and kind words that elicit their response. Oftentimes, I will say a small prayer for that child as I wonder what excuses the parents have made for being unable to love them.

There is an epidemic rarely spoken of, like a giant pink elephant sitting in the middle of the dinner table, everyone knows it is there, but they lack the strength or skills to get rid of it. Children learn their base behaviors and priorities at young ages from their parents. Parents are the primary role models of intimacy, creating nurture where nature can not. While some may have an ingrained tenderness, most adults learn how to interact with others from the example set by their parents. When the parent lacks the skills to show love, the child goes without nurture and lives void of the necessary love and attention they require to develop positive relationships. Children who go unnurtured and miss appropriate affection may lack security, have low self-esteem, and may be more likely to form inappropriate relationships at a very young age.

The perpetuation of generational abuse within families and the emotional and psychological trauma caused by such abuse leads to dysfunction, separation, divorce, and abandonment. Children who live in a home where the child is alone for long hours, in a stranger’s care, or have emotionally detached parents who rarely give positive emotional or physical attention may not understand what is missing or why. Children from homes where emotional or physical neglect occurred do not understand that their childhood lacked parental intimacy. They may see themselves as mishaps, with feelings of inadequacy without cause, and turn to drugs, alcohol, sex, or criminal activity to replace their parents’ love and attention. This seeking behavior is especially prevalent with children whose parents have separated or divorced. These children not only deal with the absence of intimacy, but they must also incorporate the feeling of their parents towards each other into their familiar relationships. Children of separation or divorce can encounter harsh and hostile behavior between their parents that often creates a situation where they are expected to choose between one parent and the other. As a result, the risk of mental illness and suicide is much higher than average. These children may carry unhealthy behaviors into their parenting, having no idea how to deal with their trauma; therefore, choosing to parent in the same manner as they were raised or refusing to parent at all.

The connection is what I describe as a love reservoir. We all have this imaginary reservoir or love tank, which is often needed to fill through nurture. An empty reservoir will drive a person to find a source of affection regardless of the supplier’s intent. Unfortunately, when our reservoir is chronically low, we often turn to self-destructive behavior to dull the feelings of want and need. We know that children who have the example of a loving parent and constant access to positive forms of physical and emotional attention are more likely to abstain from early sexual activity, avoid drug use, alcohol addiction, and are more likely to graduate from high school and attend secondary education. In addition, as adults, those who had a parental example of positive intimacy may be more likely to achieve positive long-term relationships and the ability to use positive intimacy in their parenting.

There are indications that another adult can take the place of the emotionally absent parent. For example, big Buddies, foster care, church youth groups, and after-school programs give these children access to appropriate intimate relationships that can break the familiar cycle within their family. In addition, these programs are often associated with counseling programs for wayward youth, which allows for emotional and psychiatric evaluation of at-risk children. Nevertheless, in many cases, there are long-term emotional issues that the adult child must continue exploring and dealing with to learn how to parent using positive emotional and physical.

Every time a young child throws their arms around me, I remember that what they need is a love fill-up. So, I gently hug the child back and sincerely tell them that they are loved, and I will often make a special effort to show that child positive attention. I know that I cannot save the world and that the child often needs more than I can offer; yet I wonder if my hug will be enough to remind them how precious they truly are and help them avoid the pitfalls their parents have placed in front of them.

https://www.attachmentparenting.org/

Home

Attachment Parenting Explained

The Story of the Long Labor

It’s amazing to me when women come to the birth unit and have a baby shortly after walking through the doors. They have usually spent the last few hours trying different positions and activities to get comfortable while they labor. Some take baths or showers, some sleep (or try to), some clean or cook, they eat and drink, spend time with their family and friends, and most of the time they move, move, move.

Compare that to a woman who is having an induction of labor, or comes to the birth unit very early in labor. These women often spend most of their time in a bed, in a very small room, connected to machines by very short cords. Because we limit how women in labor move, where they go, who is in the room, what they eat and drink, and what they do they are unable to follow their instincts that help ease labor and help it to progress.

Know your rights as a patient. You have the right to consent or decline any suggested interventions. This is called Informed Choice.

Position matters. Yours. Baby’s. During pregnancy. During labor.

During pregnancy being active keeps muscles strong, eating nutritious food with adequate levels of protein, calcium, vitamin D (etc) keep tissue and muscle pliable and able to change and accommodate the growing uterus. Body mechanics in pregnancy create posture, and as the baby grows posture guides the position baby settles in once baby is head down. Malnutrition, immobility, and spending much of your time reclining, and sitting with your pelvis tilted forward swing your baby’s back to your spine.

Want more information on Optimal Fetal Positioning and how posture effects your pregnancy and labor? Visit Spinning Babies

WHY? Why does this matter?

Let me tell you the most common scenario. Woman: 39 weeks pregnant getting induced for elective/social reasons. She is 1cm dilated and 80% effaced, with a Bishop’s Score of 6. Because her body is not ready for labor, we have to manipulate it with a Cook Catheter cervical dilation bulb, Cytotec, artificially removing the barrier between the baby and bacteria, and pitocin.

The body is amazing! That woman in the first paragraph, her body has been working for hours, maybe days, to prepare for active labor. However, the signal that started her body’s preparation…..was her baby. The baby starts labor. By communicating with chemicals sent to the mother’s system, the baby tells the mother’s body that it is ready to be born.

During induction we are forcing the woman’s body to labor, mechanically forcing the cervix open, making the uterine muscles contract, opening the membrane protecting the baby from outside bacteria, and creating a time limit for baby to be born. The process of labor is often slow, sometimes taking a day, two, or more. If at anytime in this process the baby or the woman’s body becomes stressed, or if the induction doesn’t produce active labor within a certain time frame surgery is performed to remove baby.

If you have had a surgical birth (cesarean) and would like support, information, or research visit ICAN

Back to posture.

If during pregnancy, labor or birth your baby assumes a position that prevents it from tucking its chin, flexing its neck, the head is sideways or baby is facing your front and not your back, labor could be long, extremely difficult, and regardless of time and effort your birth could end in a surgical birth.

There is still a chance that things can work out. Position to the rescue!

If you, your nurse, or provider know about optimal fetal positioning we might be able to, with hard work and patience, change your baby’s position. We may use the bed, chairs, the toilet, blankets, pillows, birth balls of all shapes and sizes, stretches and positions that feel foreign and uncomfortable to help change the shape of your pelvis and use gravity to help your baby change its position. As long as mom and baby are doing well with labor, we can try almost anything to help your birth go smoother, and help you achieve a vaginal birth.

Sometimes, no matter how hard we try, surgery is the best option for birth. However, the more you know, the more you can make choices that are best for you and baby through informed choice. No matter how you birth your baby, feeling empowered is a right, not a fantasy. You have the right to be as involved in your birth as you desire, and no one can take the right away from you!

What We Mean to Each Other

Christmas brings thoughts of family; and the New Year reminds us of new starts. However, for some families this means anguish, difficult memories, and turmoil. For them, the very thought of gathering with those they share DNA with causes anxiety, and even dread. This leads to increased depression, brokenness, and suicide attempts during the holidays.

Many of us with difficult pasts tend to collect friends that take the places of family members that are missing, or that we have removed from our lives. No matter how long these “Fremily” members stay in our lives, they play an integral part in how we adjust, grow and change. They mentor, they teach, they lead us to be better. They often show us that what we assimilated as normal, is actually dysfunctional, and in some cases harmful.

For me, these examples have taught me how to be a better mother, wife, friend, grandmother, coworker, Christian. I’m a better person because of those in my life who have loved and taught me. Those who give of themselves to others through example, time, and energy give us one of the greatest gifts we can receive: love.

When you grow up in an environment where interaction is unhealthy, you carry that disfunction with you into your adult relationships. The examples of love given by others teach us how to react, and interact in a healthier way. One of my favorite book series is The Five Love Languages by Gary Chapman. I found this book when our children were younger, and it truly helped me understand myself and others better.

My love language is service, with a small portion of physical touch that has been learned. My husband’s love language is words of affirmation combined with physical touch. I had to learn to be comfortable with hand holding, hugs, cuddling and other healthy forms of touch, because touch in my childhood home was either avoided or hitting. It took years to learn his love languages, but now I think I depend on it more than my husband. I have been blessed to have a husband who is kind, gentle, patient, forgiving and willing to go to marriage counseling to learn new ways for us to interact and react to each other.

In our lives, the examples of others impact who we are and who we become. When our example is hurt, anger, jealousy, emotional, physical, or sexual abuse we often normalize these behaviors. We then carry the negative into our adult relationships as we search out people who have those negative qualities we are familiar with. In contrast, those who are patient, kind and generous with their love help us to reprogram ourselves to become a better person. We then start to look for those characteristics in others, and we surround ourselves with that love.

I will ever be gratful to those who stepped in to my life to show me how to love better! They helped me become a better mother, wife, and grandmother. But most of all I’m grateful that they showed me that there was more than what I had learned as a child. The example of love is the greatest gift this world was ever given. We mean everything to each other!

When Push Comes to Shove

When my husband and I were young, our parents used corporal punishment, and when we first became parents we parented in a similar fashion. Neither of us felt like that was who we wanted to be as parents. We wanted to keep the good of our childhoods without carrying forward the negative or toxic. We have often prompted our children to do the same and make their marriage and parenting better. Within our parenting journey we found Attachment Parenting International. With this new knowledge we grew and changed, but those changes did not remove the choices we had previously made. Our older children remember being hit as punishment as a consequence of our actions.

Options in life are essential. Each of us makes decisions based on what we know, where we are physically and emotionally, who we are, where we see ourselves now and in the future, who we depend on, and who depends on us. While the variables are extensive and the possibilities endless, they often feel constrictive and limited. The choices we make impact the choices we have. You can’t take back 10 years of tobacco use that has lead to your current health crisis, or reverse the impact on your child of drug use during your pregnancy, but you can choose now to do better and be better. While starting over, changing course, improving the now doesn’t take away the consequences of previous decisions, it can create beneficial change to your future. You can choose today to do better, be better, have better, and no one has the right to limit you.

Part of advocacy is helping others find their way “right choices”. As a nurse, part of my responsibility is to assist patients in their ability to choose what is best for them in the moment they are in, without judgment or attempting to convey my opinions and biases onto their choices. There are risks and benefits to every option, and those risks and benefits depend on you. When you know more you do better!

http://www.attachmentparenting.org/

https://www.thefirstlatch.net/

https://evidencebasedbirth.com/

It’s Your Choice

We are surrounded by information. It pours from our phones, computers, TV’s, radio, billboards and those we interact with. Twenty years ago, before Google, before bluetooth and smart phones your access to information was slow. Information was found in books, magazines, and newspapers along with news and TV talk shows. The flow of information was slow, and like J. R. R. Tolkien’s Ent Treebeard said: “And we never say anything unless it is worth taking a long time to say.” The slow nature of information created a solid platform of knowledge. For the most part, people took time to validate facts before publishing in print.

Today you can think a thought and spread it like a virus to thousands of people in multiple countries without it containing one solid fact. How can you make informed decisions when you can’t tell what is real and what is false?

So, the question is, does it matter if the information is proven or fake? No it truly doesn’t matter if the information is founded in reality. Believing the moon is made out of cheese, that Mars is inhabited by little green men, or the Earth is flat isn’t harmful, unless the decisions you make based off of that information create a risk to yourself or others. Believing doesn’t make it wrong, but it could be harmful to act on false information.

Informed choice requires the knowledge of the risks and benefits of the choices you have to make. I call this the Risk/Benefit Ratio. Everything has risks. Those risks are independent to the person making the choice. The same option can have completely different risks and benefits for different people. You are the only person who can decide what risks and benefits are acceptable for you.

Oftentimes our choices are emotional, and centered on our needs in that moment. Those needs can quickly change, and your choices change with them. What others see as odd usually makes perfect sense to the decision maker.

As a nurse I believe it is imperative that I take the time to understand why a patient is making their choices while assessing their knowledge base and assist them in gathering information and facts so they can make the decision that is best for them. I don’t have to agree to support you. Its not my life and I do not live with the consequences.

Each of us deserve to have access to the information we need regarding the risks and benefits of the choices we have to make, while feeling supported in our choices. We deserve access to unbiased, balanced information that help us to make the decisions that are best at that moment, void of coercion or any attempt to sway or gain compliance.

No one has the right to suggest, expect, sway or in any way force you to make a certain decision. The ideal is that you base your decisions on factual information founded in truth, regardless of the popularity of those choices.

It’s your choice and my job is to help you achieve your wants and needs to the best of my ability.

Mental Matters

I have been pondering the moments in our lives that create challenges to our coping mechanisms. Each of us encounters these moments, often many times, throughout our lives. It begins in childhood with events that we encounter that ask us to adapt. Most children, even in the most challenging moments, assimilate the emotions and incorporate the new experience. We know that even in the most devastating situations a child can adapt and learn to cope in a way that maintains their ability to function. Much of that coping comes from ingrained personality traits we come by through genetics as well as those around us that we interact with and have influence in our lives. As we grow our ability to adapt and cope becomes more important and often harder to recover, eventually leading us through education, dating, marriage, parenting and career.

The Triangle of Health depends on the status of one to balance the other. In the moment that our physical health is impacted, our emotional and psychological health is also impaired until we can adapt by creating coping skills that once again balance our triangle. When we fail to adapt, whether it be for a short or prolonged period of time, we become mentally unwell, mentally ill.

Mental illness, like physical illness, can vary by degrees. Just as the body encounters short spurts of illness during a virus such as a cold or the flu, the mind encounters short moments of temporary illness as we adapt and cope. This most often occurs due to a one time trauma such as a car accident, the death of a pet, a challenge at work, an argument with a loved one and so on. In most cases these moments are fluid and we have encountered similar challenges before making adaptation fairly easy. These are often common, repeated events, short lived, and easy to access a support system during.

What if we encounter something more serious? Something similar to appendicitis, hip or knee replacement, in its effects on our mental health. These events are larger, take up more room in our lives, and often remove a portion of our support system such as the death of a child, spouse, or parent, chronic or terminal physical illness, the loss of a job, physical attack such as abuse or assault. For some these moments take more work to adapt, often forcing us to create or recreate coping skills and pull others in to our support circle to help us regain our health. These events may require the help of a mental health professional and medical treatment such as counseling and medication. For most, incorporating new coping skills takes time, yet once treatment turns in to healing we readjust and regain our health. Each of us will encounter 1 or 2 of these events during our life, some more, and most of us will recover well.

Then there is the mental equivalent of cancer, stroke, amputation of a limb. The catalyst can be a large one time event in our lives, or many smaller events where we have been unable to recover our health, unable to build coping skills to help us adapt and move forward. For some, chemical imbalances in the brain prevents healing. For others, the defining moment may have been so debilitating they have never been able to form coping skills to move past the psychological damage. Truly, without inherent and adaptive coping abilities, even what appears to be a small moment can cause such debilitating damage to our health triangle that each additional challenge further impairs adaptation. This creates an emergent moment that so greatly impairs our healing we become severely ill and experience psychosis. In this situation the person is no longer able to heal without intensive therapy and medical care, and even then some never regain their health. This is a medical emergency. Without treatment there is a true risk that the person will hurt themselves or others.

The fact is, each of us encounters mental illness. There is not a person born that has escaped the moments that challenge our coping skills and support circle. Hopefully these moments are sparsely scattered throughout our lives in such a way that we can recover and build on our ability to adapt, therefore making it easier for us to regain our mental health. Most of all, understanding that the human experience includes moments of mental illness should lend us to compassion, empathy, and allowance for those in the crucial moment of adaptation to their circumstances.