Midwives of the Revolution

Explorations, analysis, and reflections on women's health, midwifery, and politics from a feminist, marxist lens


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Getting ready!

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Spending this beautiful Sunday afternoon practicing surgical knots and perineal suturing. Took me a minute to remember how it works, but then it all came back to me. Next, rehearsing OB emergencies and mechanisms of delivery.

This week, I start attending deliveries! Looking forward to being there for my mamas inpatient, finally.

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The Loneliness of the First Trimester

On Thursday, I was pregnant. Seven weeks and six days of gestation. This was a very carefully timed, meticulously planned, and surprisingly quickly achieved pregnancy. On Thursday, I was happy. I had attended a meeting after work, hearing a report back from a protester that had been in the streets of Ferguson, Missouri, and analysis of police violence and the new phase in the struggle against American racism and police terrorism.

And then, I was bleeding.

I didn’t know, I couldn’t know, at first, if I would be the one in two women with first trimester bleeding, or the one in ten pregnant women overall, that would have a miscarriage, or spontaneous abortion. But I knew enough to identify that sign of bright red bleeding that doesn’t stop, when I had no risk factors for other causes of first trimester bleeding, meant I was losing this pregnancy. 

And so, by Friday, I wasn’t pregnant any more. 

And, since I’m not allowed to take any days off work until I’ve been at my job a complete six months (and I’m just three weeks shy of that), I went to work caring for women on Friday, while my uterus emptied. I felt myself bleeding while listening to a young mom’s baby’s heartbeat for the first time, celebrating with her and her beautiful partner. I patiently explained the speculum exam to a terrified young woman, and did a six-week postpartum checkup and got to coo over her gorgeous baby. I counseled an older woman on the risks and benefits of sterilization versus long-acting reversible contraception. I tried to have a normal day, when I wanted to be home, mourning. 

It’s only Saturday, and I’m still pretty devastated. I was supposed to attend my city’s SlutWalk protest, where a year ago, I had given a rousing speech tearing apart sexism. I wanted to be standing with my sisters and comrades in the streets. But more so, I need to heal.

***

I have been musing quietly about the loneliness of the first trimester since I peed on the stick weeks back and had the delightful moment of reading “pregnant” on the digital screen. The feeling was so different from the myriad other times in my life when I had taken the test in anguish — especially the one other time when I had a positive result, in midwifery school, and knew I was going to have an abortion. I was, this time, elated. 

But there is convention in our society to stay quiet about that positive pregnancy test until the second trimester, regardless of which choice we plan to make about the pregnancy. We know that people won’t really understand the complexity of our feelings about the pregnancy, and that we don’t want to tell everybody the bad news, if we end up needing or wanting an abortion, or if the pregnancy ends in a miscarriage. And so we tend to suffer through many discomforts of the first trimester, in silence.

I remember telling some of my comrades and friends what was going on, when I had the unplanned pregnancy years back. Because I am part of a community that embraces reproductive rights, I was fortunate that it was fairly easy for me to tell people at the time that I was planning an abortion, or that I was still dealing with some of the medical issues related to my abortion the few months after it started. I have since publicly spoken out about my abortion many times, working to de-stigmatize the experience that three in ten women will experience before the age of 45

Telling abortion or miscarriage stories can be a powerful way to break the silence. But it will take more than telling stories to break the stigma.

Telling abortion or miscarriage stories can be a powerful way to break the silence. But it will take more than telling stories to break the stigma. Art by Favianna Rodrigeuz, Just Seeds Cooperative

At that time, however, I didn’t talk openly about what was going on outside my activist network. But I did have a fellow midwife student classmate and friend who turned out to have an unplanned pregnancy at the exact same time as me. We turned to each other one day after class with our secrets: “I’m pregnant.” Neither of us felt good about it. We were both in the first of our two year program, and planned to go full time. There was no time for pregnancy, birth, and parenting, and both of us had partners that were full time graduate or professional school students. It was terrible timing. We each made different decisions, however. I ended my pregnancy, while she continued hers and is parenting this beautiful child, who is almost three now. 

The other difference between us was that none of our classmates knew that I was pregnant or had an abortion, while they eventually found out about hers, when she started showing and eventually had the baby during the program. We both knew that even in a midwifery program, people weren’t emotionally intelligent enough to deal with a sister midwife’s pregnancy to respond appropriately to our news. So we both kept quiet, attending class while coping with our own pregnancy challenges.

I have wondered sometimes if we would have felt that way if we were attending school in a more politicized or radical time, say at the height of second or third wave feminism. Interestingly, I was able to talk about it with my faculty and preceptors, who all had trained as midwives in more political times and were very accepting of my decision.

If a group of midwife students can’t be mature enough to be present with each other during pregnancy, who can be?

***

This time around, I spent much of the initial weeks of pregnancy being silently excited. I talked about it with few people: my mother, my partner, my nurse-midwife team, and one friend, whom I had asked to be my birth doula. It was strange not revealing the news when talking to friends and family about this big thing that was going on in my life. Many times, I wanted to tell more people. It was humbling to now be experiencing life as a “pregnant patient,” much as I had appreciated the experience of being the “abortion patient,” knowing that this would make me a more compassionate nurse-midwife.

And I continued with my life — bicycling, gardening, going to protests, working long hours, cleaning my house — while thinking about the little life growing inside me. Fantasizing about the home birth I expected to have in early April with the fabulous team of midwives I had chosen to care for me. Talking with my partner about changing the guest room into the baby room over the winter. Getting excited about the cousins our baby was going to have, given that my sister in law is pregnant with her second, and my brother and his wife might be trying to conceive soon. Planning with my partner how we were going to cleverly announce my pregnancy on Facebook and to friends in person. Looking forward to the excitement and congratulations we could expect from family, comrades, and friends. And trying to imagine what it would be like to meet that tiny creature my partner and I had created. 

***

I was starting in some ways to relish the privacy of the last couple of months. It has meant more time for introspection, self-care, and focus. I have needed that inner space to deal with some significant changes to my body and my changing life priorities. 

Like sobriety. I chose to stop drinking around the time that I believed I was ovulating, in the first cycle we tried to (and did) conceive. I genuinely enjoy beer, wine, and the occasional cocktail, but since beginning my new job for the last few months at my job, I had also relied on that delicious glass of wine after work to help me unwind. Being sober means having to actually face all the trauma I see at work, and process it in some other way. And this is a pretty drug- and alcohol- heavy society we live in, so not drinking or partaking in any drugs can be pretty challenging, socially and personally. I have loads of patients that aren’t able to cope with life without substances, and continue drinking and using (marijuana, mostly) during pregnancy. Like many women facing the prospect of complete sobriety for 40 weeks, I worried that I would be tempted to drink and felt guilty for even thinking it might be hard to stop.

Fortunately, I have felt pretty good about not drinking and have enjoyed the challenge of sobriety. But I also dreaded social situations in which I would normally be drinking, worried someone would ask why I am not having my customary glass (or three) of wine. What would I say if someone suggested I was not drinking because I was pregnant? Would I choose to tell them? Would I lie? Would I tell them I didn’t want to talk about it? Fortunately it never came up. (For the record, peeps: Don’t ever ask someone if they are pregnant! They will tell you if they want you to know!)

Another major chemical change occurred in my body as I prepared my body for pregnancy by weaning myself off the anti-depressant I had been taking the last few years. That drug had really helped me through some major difficulties the last few years, from completing my midwifery program, to facing my midwifery board certification, to an extended job search, to the major transition of this new and difficult job I eventually landed and accepted. I am fortunate that my depression is well enough managed, and I am stable enough to face stress without the help of this wonderful pharmaceutical product or alcohol. Mostly I owe that to years of therapy and yoga practice that have enabled me to access pretty decent coping skills, along with an extremely supportive partner. Nonetheless, it felt very difficult to stop drinking and to stop taking this antidepressant at the same time. In hindsight, I may have done it a little differently, but it worked out OK. 

Mainly, the changes in my body with the new pregnancy made me feel extremely vulnerable. I knew I had little control over if this pregnancy would continue successfully or not — knowing what I do about rates and causes of miscarriage. For the first few weeks, I could hardly believe I was really pregnant! Every trip to the bathroom, I feared seeing blood on the tissue paper. Every little tiny cramp or feeling in my pelvic area felt like it could be something wrong with the pregnancy. And since I only experienced momentary twinges of nausea, I looked forward to them, as proof that I was in fact pregnant. I caught myself looking at my breasts in the mirror and sometimes touching them to make sure they were really growing, and tender enough. Loads of women face extreme nausea and vomiting in the first trimester and are completely miserable, whether or not the pregnancy is desired or if she plans to continue it. I’m fortunate I was at least feeling well. 

And when the proof was there, out of nowhere — sustained bright red vaginal bleeding, cramping, and passing tissue — it was clear that it was all over, in a flash. One day, a pregnant patient, the next, a “miscarriage patient.” And I had to believe there was nothing I could have done differently. It wasn’t my fault. It just wan’t going to work out this time. 

***

These are some of the things we don’t talk about when we talk about pregnancy, planned or unplanned; desired, undesired, or ambivalent; spontaneously aborted, continued successfully, or electively aborted. These are some of the things we don’t talk about because we have internalized the messages of the war on women. This war psychically imposes a social and cultural expectation that all women naturally 1. want to become a mother and should embrace every chance at motherhood, no matter the circumstances; and 2. adjust and cope in a healthy way to the emotional and physical challenges of pregnancy. And if they don’t, there is something wrong, or even criminal in her thoughts or actions. Yes, lawmakers have proposed criminalizing miscarriage. Yes, every year, dozens of laws in every state of the United States are proposed and pass regulating women’s bodies and restricting abortion. Yes, laws primarily aimed at Black women  criminalize drug and alcohol use in pregnancy (see Dorothy Roberts’s Killing the Black Body).

Yes, this impacts popular opinion, and shapes how people–even and maybe especially women themselves–understand and talk about pregnancy, abortion, miscarriage, and motherhood. And mostly creates the circumstances for not understanding what it is to be pregnant, or how to empathize with a woman who is pregnant, or wants, does not want, or who cannot achieve pregnancy or parenting. 

***
I was grateful I was pregnant on Thursday, and still sad that I’m saying goodbye to that little embryo that I hoped would become a fetus and eventually the baby I would get to parent. I am nervous about what happens next. Will I be able to get pregnant again right away? What kind of loneliness and fear will I face the second time around? Will I make it past the eight week mark next time? Will my readers and friends respond compassionately to this post? 

I feel like I’m in a good enough place emotionally to be able to share my miscarriage story, alongside my abortion story. And like coming out about being queer, or about having had an abortion, I hope that by telling my story, I can contribute to de-stigmatizing something that our deeply misogynistic society doesn’t understand. 

But it takes more than being able to tell the story, for those of us for whom it is safe to do so, to change cultural values around pregnancy and sexuality. We have to end the war on women if we want to shift people’s consciousness and foster solidarity with the challenges people face during pregnancy and parenting. How could we do that? It means opposing every state/federal/local law and institutional policy that aims to decrease women’s bodily autonomy and impose control over women’s sexuality. It means being in solidarity against every form of sexual violence and coercion. It means fighting to end the New Jim Crow. It means demanding comprehensive sexual education for all children. It means standing up for a living wage, the right to union representation, and dignity on the job. It means building a movement for immigrant rights and to tear down the borders. It means calling for free quality childcare and the valuing of care work. 

Some of these things might seem far-fetched and maybe even only tangentially related to my story. Maybe you think I am coming out of left field?

But there used to be a saying in the women’s movement that really meant something, though it has ceased to bear any resemblance to its original meaning: “The personal is political.” In its best sense, it meant that our personal struggles as women or as women of color, weren’t ours alone, but a reflection, or a symptom, of the broader racism and sexism in society. In the era of neoliberalism, we are meant to see our problems as isolated from each other’s, and mostly as a reflection of our own personal weaknesses and inner failings.

More and more, however, I am seeing my personal struggles as intimately related to the structures of social oppression, and I’m tired of bearing them alone. When I fight against the war on women, or against the war on the poor, or the war on people of color, it’s personal. It’s deeply political, as well, but when I think about the circumstances of my reproduction, it’s also deeply personal. 

***

The last women’s movement, like the civil rights and Black Power movements, changed culture dramatically — but throughout my entire lifetime, the right wing has undertaken a sustained attack on the progress those movements made possible. It is my hope that we can build new social struggles from the ground up, that take up some of the demands I mentioned above, and more. Yet most of all, my hope and my argument is that the voices and demands of ordinary people as we struggle with our “personal” issues must be at the forefront of these movements — rather than the tepid Democratic Party politicians and NGO leaders who have been too afraid about upsetting the right wing that they have done nothing but compromise while our rights are under attack.

After all, it was- not well-meaning liberal politicians that made Roe v. Wade possible, but the fact that women took to the streets to tell their own stories about illegal abortion and forced sterilization. Those movements put women first — not the careers of politicians or career “activists.” Change happened, then, and it happens now, from the bottom, up. Or, as the late, great historian Howard Zinn put it, “What matters most is not who is sitting in the White House, but ‘who is sitting in’ — and who is marching outside the White House, pushing for change.” 

I don’t think the first trimester, or any part of pregnancy or parenting, has to be lonely. I know that people can develop deep empathy and solidarity with each other’s struggles — and we see a glimmer of that in every mass movement, from the revolution in Egypt to the capitol occupation in Wisconsin, to Occupy Wall Street, and even how people looked after each other in the immediate aftermath of Hurricane Katrina. We have to foster that in our communities as much as we can, but more so, we have to organize movements for reproductive justice that put the demands, voices, and strategies of ordinary women and other people who can get pregnant at the forefront.

Being part of those social movement traditions is what makes me feel a little less lonely as I grieve my lost pregnancy and look forward to the future. 


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Surprise! Anti-Abortion Lies Across America!

Where do I begin with what is wrong with this ad?

The fact that a dad was surprised that he got someone pregnant, for one.

The fact that this suggests a cute baby is all women need to convince them that they should accept and embrace any surprise pregnancy, for two.

That the fact a potential baby has a heartbeat is supposed to sway an actual human that she shouldn’t have an abortion, for another.

But really, the fact that this has been up and prominent on my commute route home for at least two months and it hasn’t been defaced, is what really bums me out. I’m not saying that y’all should go out and mess it up. But if there was a movement to turn the tide against this kind of anti-woman garbage, that might have happened.

We have a lot of work to do to de-stigmatize abortion. These kinds of billboards show us our work is cut out for us. We desperately need a movement in the streets that proclaims that whatever the reason a person wants to terminate a pregnancy is ok.

Only a pregnant person can know if it’s right to continue a pregnancy, whether it was a surprise (for her or the sperm donor) or not. I look forward to the day such messages of reproductive freedom are found publicly and beautifully in public spaces, paid and not.


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Some Things I Have Been Thinking About in the Realm of Reproductive Justice

I wouldn’t be a very good Marxist or feminist midwife if I didn’t have some things to say about what’s going on in the world. But once my first three months of the new job were over, I finally had energy to do more political work, and therefore have had less time for blogging.

I am trying to carve out more time to write on this forum about the ongoing war on women, and what people of all genders and political persuasions can and are doing to fight it. I wanted to share just a few things here about what I’ve been thinking about, and that I hope to explore more in later, more in depth posts.

Hobby Lobby Protest

The Hobby Lobby decision prompted immediate protest at the grassroots

First, the Hobby Lobby Supreme Court decision of last month irked me more than I can say. It was an insult to science and to “freedom” and to women’s bodily autonomy. And so everything I wanted to say about it was published over at SocialistWorker.org, in this piece: “The ‘Freedom’ to Deny Women Healthcare.” I have more to say on the resistance to that decision, especially how defensive everyone is about contraception, but that will hopefully be developed in another upcoming article in that publication.

Also, I follow with great interest the ongoing legal battles over forced surgical birth, and their connection to abortion and other reproductive rights in this country. I really liked this piece, and laud Jennifer Goodall for her courageous stance for normal birth after c-section: “Pregnant Women Warned: Consent to Surgical Birth or Else.” Women losing the right to how they give birth is intimately connected to the right to contraception and abortion — another topic I look forward to exploring more in this space and others. 

Obvious Child

You must see this film. #ObviousChild

On a lighter note, I LOVED seeing Obvious Child in the theaters on its brief stint in my city. What a *fabulous* and hilarious comedy about abortion, of all wonderful things. There is nothing so wonderful as a bunch of sex-positive, abortion-positive, pro-woman people dealing with an unplanned pregnancy in a very real way on the big screen. I have heard people say that if Knocked Up or Juno were about abortion, there wouldn’t have been a story. But guess what — you can have a story when an unplanned pregnancy results in abortion (like half of all unplanned pregnancies do in this country) — that story just happens to then focus on the woman herself. Revolutionary. 

Finally, I am sick to death of the divisive commentary that passes for analysis about why the LGBT movement has made strides, while the war on women continues. This disturbing piece from the Daily Beast, “Ten Reasons Women Are Losing While Gays Keep Winning” has its response from yours truly coming up quickly. Suffice it to say that biological determinism has no role in progressive analysis, and apology about abortion is what got us further entrenched in the war on women, and will not provide our way out.

* * * * *

Too many teasers? Sorry. Let’s say this is my way of holding myself accountable to myself and my readers. It shall be written!


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Resisting a Dangerous Consequence of Privatizing Medicaid

As of July 1 this year, my state has adopted an HMO model for its Medicaid plans. All Medicaid members have been assigned a primary care provider in the network. Many members were bumped from the regular Medicaid onto one of the handful of private insurance companies this state’s Medicaid has contracted with. This will be a disaster for patients in loads of ways: private insurance is part of the problem with peoples’ access to healthcare in the United States. Those insurance companies and the underfunded state programs are really the only ones for whom this can be seen in any way as part of a solution. What a boon for Blue Cross Blue Shield, Humana, and a host of other for profit corporations that they now have millions more customers handed to them from state governments. 

As with all of the reforms packaged with the Affordable Care Act, I am waiting to see how it will all shake out. So far, however, I have noticed that a huge problem for patients is how difficult it is to navigate these plans. And from a provider standpoint, it is much more confusing. Where do we send our OB patients for ultrasound or to see a Maternal-Fetal Medicine specialist when their pregnancy is complicated? Well, it depends on their insurance. Whereas many area hospitals still accept regular Medicaid, many have decided not to contract with some of these new private Medicaid plans. So depending on the managed care plan you were assigned, you may have to travel farther to get care than previously. 

One plan in particular has been on my shit list for years. My clinic actually does have a contract with this company, so this is the first time I’ve seen up close how it operates — everywhere else I’ve worked or had a student rotation at didn’t take it. They used to do this direct marketing thing — set up a booth at the shopping mall or in the neighborhood and offer women diapers, coupons, and other incentives to get them to switch to their plan. The woman would sign up only to find that she now cannot go to the clinic where she already had established care. Luckily, this practice is no longer allowed, so in theory patients are signing up for more above-board reasons.

Their prescription drug coverage remains a reason for me to campaign against them. Regular Medicaid in my state is not perfect — but the drugs they cover actually make medical sense (though there are loads of gaps). Now, when prescribing, we have to look up the formulary for myriad private Medicaid plans. (And don’t get me started on the limitations of contraceptive coverage on regular or these private plans, even with the contraceptive mandate.) Insurance, not public health, is determining many of my medical treatments. This is not a rational healthcare delivery system.

injection medicationThe absolute tip of the iceberg for me, though, with privatized Medicaid, is the requirement for the provider or pharmacy to submit a prior authorization request when prescribing treatment for two conditions that I see pretty frequently: gonorrhea (which includes injection of a drug called ceftriaxone) and Pelvic Inflammatory Disease (PID) (which requires both ceftriaxone and 14 days of oral doxycycline). 

What is prior authorization? Basically, a road-block to getting my patient the necessary treatment immediately at the time of diagnosis. It means that either the pharmacy or I have to submit an form to the insurance company explaining my medical rationale for scripting this drug. We fax the request and then wait 24-48 hours for it to be approved. 

The request is invariably granted. They pay it. Then we have to get the patient back into the clinic pharmacy to pick up the medication, and in the case of ceftriaxone, to get an injection from clinical staff (it cannot be injected in the pharmacy). Some clinics get around this by stocking the medication themselves, but that is not an expense my clinic is able to take on.

These antibiotics are expensive, and should not be. But it is not as though we are throwing either around unnecessarily. Believe me, it is very important to not over-prescribe antibiotics. But is cost the only factor to consider in treatment? Don’t patients deserve to get appropriate treatment for infections that can have some pretty horrific consequences if not treated correctly

I believe that we who hold that healthcare is a right have a duty to work together to crack open the continuing gaps in the new healthcare systems and fight for one that includes everyone (and yes, that means including undocumented immigrants) and covers all basic healthcare as a human right. I plan on campaigning against privatized Medicaid, and this is just one example of how a for-profit corporation is putting their profits ahead of public health in that privatized system.

To that end, I wanted to share with you a letter that I sent to that private Medicaid contractor that requires prior authorization. I was fed up. And two weeks after sending it, I received a call from one of their representatives asking for more background on why I sent the letter. I’m not convinced this is the end of it, but I am happy to say that the representative reported to me that she would pass my concerns on to people [who I deduce are the company pharmacists] that make formulary decisions. 

If you are a healthcare provider dealing with this issue in your patient population, I heartily encourage you to pick up the phone and add your voice to the dissent. Or copy and paste elements of my letter and forward on to the insurance company that corresponds in your instance.

We are many. They need to hear from us.

 

***

Hello,

I am writing today because I am very concerned about the prior authorization requirement for medication ceftriaxone (Rocephin) and doxycycline. According to the Centers for Disease Control, a one-time injection of 250mg of ceftriaxone is the most appropriate treatment for gonorrhea (to be prescribed with azithromycin or equivalent). It is also the best treatment for pelvic inflammatory disease, along with 100mg oral doxycycline for 14 days.

As a women’s health provider, many patients present to my office with one or both of these conditions, requiring immediate treatment. Due to your organization’s prior authorization requirement for these medications, my [private corporation contracted] Medicaid patients face an unnecessary and potentially unsafe barrier when seeking treatment for these conditions. The prior authorization requirement means that complete treatment is delayed for these patients. I work in a setting for which transportation to the health clinic can be a significant issue – patients often report they delay seeking care due to economic and transportation barriers. It may not be easy for the patient to present to the clinic on a different day to pick up the prescription from the pharmacy and then receive the injection from our staff.

In addition to facing the stigma and emotional stress of having a sexually transmitted infection or PID, which can threaten a patient’s future fertility, this added barrier of delaying ceftriaxone treatment not only increases the emotional toll of such an infection – it also increases the threat of antibiotic resistance. If patients are not able to complete the full dose of the last remaining medication we have to treat gonorrhea, we could see an increase in resistance. Injection treatment for gonorrhea is supposed to help decrease antibiotic resistance. The prior authorization requirement runs the risk of making this an infection that can become even more threatening in not only the community I serve, but on a larger scale as well.

I am extremely concerned about the barrier that prior authorization requirement for these two medications creates for my patients, who deserve nothing less than safe and compassionate quality healthcare. I hope you will add ceftriaxone and 100mg doxycycline to the preferred drug list immediately, so we can enhance our patients’ access to care and improve public health.

Thank you for your attention to this matter. I look forward to hearing from you

Sincerely,

A Concerned Certified Nurse Midwife

Clinic X


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Clinical Resources for Providers & Patients

One of my major roles as a provider is to counsel patients about their health and link them with resources. I also spend a great deal of time educating myself about women’s health, since being a clinician requires lifelong learning — especially evident at the beginning of my career. I have compiled a pretty sweet resources list that I wanted to share, featuring legit, evidence-based sources that I trust.

I’ve arranged it by subject area and include a bit of info about its intended use. Enjoy, and please provide me with feedback — what works, what could be added, what’s maybe not so good.

Holistic Approaches Women’s Preventive Health & Primary Care

From the website: “Bright Futures for Women’s Health and Wellness implements and evaluates culturally competent, evidence-based consumer, provider, and community tools for women across their lifespan. Bright Futures for Women’s Health and Wellness materials help women of all ages achieve better physical, emotional, social, and spiritual health by encouraging healthy practices.” That side Includes resources on physical activity, nutrition, emotional wellness, and maternal wellness.

This is a great handout for patients developed by the Western Australian government’s public health department on sleep hygiene that I use often.

I post this visual aid developed by the Harvard Medical School in my exam rooms, to demonstrate a healthy food plate. It’s improved over the FDA’s food pyramid.

A good complement is this schematic of the Healthy Mind Platter, to demonstrate mental activities essential to mental health promotion.

Say what you will about the US Preventive Services Task Force (USPFT) — their resources are incredibly useful. This source walks you through the organization’s screening, counseling, and preventive medication recommendations.

This government site includes resources for patients and clinicians, including continuing medical education (CME) that midwives, other APNs, and docs might find useful. Topics include: CancerDiabetesGenitourinary ConditionsGynecologyHeart and Blood Vessel ConditionsMental HealthMuscle, Bone, and Joint Conditions, & Pregnancy and Childbirth

I really don’t know much about this organization, but what I’ve seen looks pretty great: Integrative Medicine for the Underserved provides community and resource-sharing for folks interested in this area.

Reproductive Health

CARDEAI recently learned about CARDEA by participating in an excellent series of CME events about providing care for transgender clients. They have lots of resources and offer training on a variety of topics you can peruse here. They seem to focus on reproductive health and “wraparound” services.

For STI prevention, treatment, and counseling, the CDC is tops. I have read the CDC’s STD Treatment Guidelines front to back more than once. If you provide any reproductive health services, it’s a must read. This is a library of resources straight from the CDC.

After you’ve done the CDC thing, I encourage you to hang out with the American Sexual Health Association. Their Herpes Resource Center is fantastic, but their overall positivASHAe and holistic approach to sexual health shines through everything they do. I’ve not used them, but they have brochures on STIs and other sexual health topics you can order for your clinic that look pretty good. And an intriguing book they recently published: Creating a Sexually Healthy Nation. Yes, please.

The National Chlamydia Coalition is seriously dedicated to our most common bacterial STI, chlamydia!

There isn’t any current medical consensus on the breast self-exam (BSE), but I still teach and encourage it, as it promotes awareness of the woman’s body. Here’s a link to a good teaching tool for the BSE.

I like this handout on kegel (pelvic floor or vaginal) exercises. Yay, vag workouts!

This is a comprehensive guide to female sexual health and wellness that everyone should read! It covers everything and is basically a course on female sexuality. Woot! Thanks again, ARHP!

General Clinical Practice

This Health Literacy Universal Precautions toolkit “offers primary care practices a way to assess their services for health literacy considerations, raise awareness of the entire staff, and work on specific areas.”

Cervical Cytology & Pathology (AKA Pap Stuff)

ASCCP_HeaderGraphicThe medical world hasn’t entirely caught up yet, but the American Society for Colposcopy & Cervical Pathology released its consensus guidelines on pap screening and followup a couple years ago. Hang out at their website to get the backstory and summary of screening and management guidelines.

OK, so this resource for clinics on managing HPV did get some funding from some pharmaceutical giants, but provides guidance on HPV management on a wide variety of issues/from different angles.

Family Planning & Abortion

For contraceptive prescribing, always start with the CDC. Here’s their Selected Practice Recommendations on Contraceptive Use. And don’t forget the Medical Eligibility Criteria.

My favorite new thing from the CDC. Highly recommended reading on providing comprehensive family planning services.

I am a proud member of the Association of Reproductive Health Professionals (ARHP)! Here is a page full of their patient fact sheets and patient resources on family planning.

The You Decide Toolkit is also from ARHP and “is designed to help health care providers better understand and speak to the risks and benefits of hormonal contraception.

The mama of all abortion resources is the National Abortion Federation. Their site can connect you with all the info you could ever want — from medical to political to funding issues.

RHAPThe Reproductive Health Access Project “seeks to ensure that women and teens at every socioeconomic level can readily obtain birth control and abortion from their own primary care clinician.” Their site has invaluable resources, from contraception info to miscarriage management to tools to help primary pare providers integrate comprehensive reproductive healthcare into their practice.

Backline, Connect & Breathe, and Exhale are all terrific organizations dedicated to providing options counseling and pro-choice, affirming post-abortion counseling.

Bedsider is a pretty hip, patient-centered site for helping people find the right birth control method.

It may not be the best place to work, but Planned Parenthood is still the best and biggest organization nationally providing evidence-based family planning services. Their site has lots of great health info.

The University of Chicago recently unveiled the guide Accessing Abortion in Illinois, which provides a very holistic approach “to help health and social service providers advise pregnant persons who may be seeking abortion care in Illinois.” Rad!

Pre-Conception & Fertility Promotion

CDC at it again — here’s a pretty old but still useful guide on improving preconception care as a public health concern.

Loads of stuff on planning pregnancy. March of Dimes has this stuff on their website on pregnancy planning, but no great stuff you can print (or integrate into your electronic medical record handouts).

I don’t know much about this organization, but Attain Fertility seems to have some good stuff for helping people get pregnant and info on IVF and fertility treatments.

I found this resource list that seems pretty comprehensive, including transgender parenting, same sex parents, and single parenting by choice. Nice!

Before & BeyondBefore, Between, and Beyond is “the national preconception curriculum and resource guide for clinicians.”

Every Woman California is a public health initiative in that state with resources on preconception heath that may be useful to folks in other areas.

Pregnancy

More goodness from the CDC. Links to pre-conception, contraception, pregnancy itselfpostpartum, and even basic infertility care and resources.

And from a different government agency (why are there so many?) through US Department of Health & Human Services, there’s this resource, with same topic areas covering pregnancy.

Childbirth ConnectionChildbirth Connection has almost 100 year old roots in being a resource for mamas in the US. This site is at a higher literacy level than many of my patients, so I mainly use this for my own reference on pregnancy, prenatal care, labor and birth issues, postpartum, and lactation. Others may find its utility as a direct patient resource. Fantastic, pro-woman, pro-midwifery organization and site.

Mother To Baby has a great collection of patient handouts on medication use in pregnancy that I frequently use. English & Spanish! They will also personally answer your clinical questions about drugs in pregnancy for stuff that’s not on the website. They also have evidence-based fact sheets on illicit drug use in pregnancy, but so far only cover three.

This is a patient worksheet you can use at the 6 week postpartum checkup, brought to you by our friends over at ARHP.

Woah! This app looks pretty cool — for mamas to trace embryonic and fetal development.

Some Sites for Continuing Medical Education

ARHQ sponsors some great, free, evidence-based CME activities on disease prevention and care management that you can find here.

More goodies from ARHP can be found in these Clinical Minute activities on family planning issues. They also have great webinars that may draw from their annual Reproductive Health conference content. As if that wasn’t enough, they also have CORE for additional repro health curricula.

Before, Between, & Beyond has CME on preconception topics.

Medications

I often use GoodRx.com to find drug discounts and coupons for uninsured patients. The site can text or email the coupon to the patient. You just have to find out which pharmacy they want to use.

Target and Walmart both have cheap generic medications available. If patient is uninsured, try to prescribe drugs off these lists and explain why you recommend filling the script at those stores.

ARHPedia_logoARHPedia (sound familiar?) is another source through ARHP: “the comprehensive source for resources on pharmaceutical products,” including coupons/samples/vouchers, patient education, patient assistance, and more.


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Updates Galore!

I have made it past the 3 month mark…it’s hard to believe it’s only been three months. Almost four now, but still…

Here are some highlights and lowlights from my world these days…

1. Looking forward to the Socialism Conference.

It’s this weekend — an extended conference this year, it started today. But I can’t take any days off work until my six month work anniversary, so I’ll only be attending Saturday and Sunday. Here are some talks and featured events this year that I’m looking forward to:

Special Education & Disability Rights

Marxism and indigenous feminism

Women, race, and class: A history of Black feminism

Who needs gender? A Marxist analysis

Capital’s missing book: Social reproduction theory and the global working class today

Who cares: Work, gender, and the repro­duction of labor power

From criminalization to “rape culture”: Re­thinking the politics of sexual violence

From restrictions to criminalization: The fight for reproductive rights today

Capitalism, socialism, and mental illness

What should socialists say about privilege checking?

Microbes and Marxism: Capitalism and public health

“Obamacare” as neoliberal health care reform

…OMG there is so much! Obviously won’t be able to make it to all of those sessions, but those are some of the ones I thought might be of particular interest to readers, and which speak to some topics I’ve been thinking about/excited about lately.

2. I’m sick of the judging.

I feel like everyone I work with is burnt out and cynical. I’m sick of victim blaming, slut shaming, poverty-ignoring, moralizing attitudes coming from people I work with. Especially the OB I work with. It’s poisonous, and trying to figure out how to respond with fierce compassion. Patients and staff deserve to feel human. 

3. Getting into the hospital…

This will of course bring new challenges. Now, I kinda have it good. Getting used to being in clinic full time, getting to know my patients, learning what basic and expanded skills I need to have for clinic. But it will be nice, come September (fingers crossed!), to have hospital privileges so I can actually start to be present with my patients in the hospital. I still have to have a bunch of deliveries supervised by the aforementioned physician, and hopefully by some midwives I’ll be working with, but it’s good to know it’s on the horizon. 

4. Got a rad shout-out by the fabulous Feminist Midwife!

My friend, mentor, and trail-blazing hero over at Feminist Midwife gave me and a fellow red midwife a lovely mention in her recent post here, honoring the work of sharing the journey via the blogosphere. Thanks, FM!

5. Feeling appreciated

Though every day is emotionally and clinically challenging, it is also rewarding. I am feeling every day that I make a difference when I provide good care, and I can see it in my patients’ faces and in their continuing to come in for care and opening up to me. Another perk is outside of clinic — being known among friends, fellow activists, and family, as someone who knows some things about reproductive health — and who can be trusted to ask about it. Maybe it’ll get old one day, but I doubt it. I love those calls/texts/FB messages about family planning, pregnancy, and sexual health. So, thank you to those folks who have come to me with those questions, and I hope I have been helpful.