Tuesday, September 27, 2016

On Crossing the Picket Line

An open letter to my fellow nurses, on strike this week:

My Fellow Nurses, 

     This week, on Wednesday, you walk out of your facility for 5 days. The same day, I and 350+ nurses walk in to take your place. Historically, those who cross the picket lines of a strike are called "scabs" by the strikers and others.   I also know that historically that term has also been a derogatory term, but I will set that aside and use that term for simplicity's sake. For decades, when employees feel oppressed or mistreated by their employers, and negotiations fail to result in adequate changes, the employees unionize, and go on strike. In mills, factories, mining sites, and grocery stores, unions have protected the rights of workers, allowing them to stand up for safer workplaces, better pay, and other reasonable demands. Unions and strikes have lead to labor legislation, changes in safety practices, and better pay and benefits. By flexing their collective power, employees get their employers to listen. A strike, as a heavy duty weapon, forces employers to listen by hitting them where it hurts - their bottom line. Companies can't make money if they can't make or move products, because their workers walk out and the production line stops. 

     So then, what if the industry is not a factory or a coal mine, but a hospital? What if the "product" is not an item, but a human being, in the form of a patient? 

     In other industries, "scabs" allow the employer to hold out longer and not give in to their employees' demands, because the industry can continue. But what if the industry will keep going with or without the workers, because the production line has no stop button? What if patients still come into the ER, still stay in the ICU and can't transfer, or have an urgent need for surgery? Nursing and health care are not like other industries. While a factory may be able to shut down for awhile with the only impact on the products and the market, a hospital can't shut down, and without nurses, patients' lives are at risk. 

     There are some nurses who still feel that other nurses betray them by coming to work in their place. But without those travel nurses in their place, eventually nurses would not be allowed to strike, because laws would be passed to protect the public from the risks. 

     Some nurses understand that nurses have to take their place when they strike, but they still believe the "scabs" help the employer not feel the brunt of the strike. Does it? Unionized hospitals carry strike insurance, which means that a great deal of the expenses they pay to have travel nurses come cover the strikers are covered. However, strikes are still very expensive for the hospital, and the costs are not always covered entirely by the strike insurance. In addition to the hourly wages of the incoming nurses (usually significantly higher than the typical wage), they also pay for their document processing, orientation, lodging, transportation, security, and travel. Traveling last minute gets expensive, so instead of paying $200-400 like you would ahead of time, they are paying $1200 for the same trip. The agency that finds and processes the nurses gets paid to do so, as well as to run the strike coverage from on site. The hospital also continues to pay benefits for all their regular employees. Additionally, patients are often diverted from the hospital when possible in order to offload it when it has minimal staff. Patients with elective procedures may reschedule or switch hospitals if they are able. The hospital loses out on the profits from those patients, even though there are nurses covering the strike.  One of the most impactful aspects of a strike, though the least quantifiable, is the impact on a hospital's public image. For healthcare facilities, the trust of the community is vital. When nurses go on strike, it hurts the facility's relationship with its community. It also impacts stakeholders and future employees, who may find out about the strike and decide not to invest there or work there. 

     "Scabs" are a necessary part of protecting nurses' right to strike, and protecting the patients of that community during a strike. 

     To my fellow nurses, who walk out of their facility this week, to ask primarily for better staffing policies so that they aren't working so much overtime that they all burn out, I support you. I hope your employer gives you what you feel you need to function, and that the strike helps resolve the situation. I hope that striking doesn't hurt any of you financially, since hopefully the union dues will help offset lost wages. Most of all, I hope you know that I will care for your patients to the best of my ability, so that they feel safe and you don't have to worry about them. I hope the minor chaos in the facility caused by bringing in so many new nurses only brings awareness to the patients and their families, so that the community will be on your side. Know that I will be speaking of you in supportive ways when I speak to members of your community. By being here, I hope I hurt your employer enough financially that it just makes sense to them to give you what you're asking for. I am glad that I can enable you to fight for your rights and stand up for yourselves, because I understand that a strike is never undertaken lightly. 

Saturday, December 6, 2014

On New Motherhood

I am a mom.  It’s still a little weird to realize that.  My son is now two and a half months old, and that thought still hits me every so often (more so the first two months).  The following post might end up being a jumbled, rambling verbalization about my thoughts on motherhood.  Mostly because I am chronically sleep deprived, and this post has taken awhile to put together.  Please note, I will use “I” throughout because I am speaking for myself, but my husband is a very involved father and is absolutely my parenting partner, so this is not to exclude him!

I have found motherhood to be exhausting, time consuming, frustrating, challenging, humbling, and incredibly rewarding.  There are times when I have felt like I just have no idea what I am doing or what this child needs, and times when I am so tired that I have desperately wanted to just check out, handing the baby off to someone else and just crashing for hours.  I guess I didn’t expect to feel so unprepared and as frequently overwhelmed as I have (though I really can’t say I’ve felt that way a lot).  I have a lot of child care experience, so I think I expected to be above average compared to an average new parent. Despite my twelve years or so of babysitting (“parenting practice” I’d call it sometimes), I still have never cared for a newborn for any length of time.  I have to remind myself of this when I find myself thinking that I should know better how to do all this, and cut myself some slack.  I am definitely my own worst critic.  

The hardest thing has been sleep and scheduling.  I knew that we would be sleep deprived, but that is something you can know in your head, and still be knocked over by when you experience it.  Someone told me recently that she thought there should be a different word or phrase besides “tired” to describe “new mom tired”.  I can’t agree more.  This baby is not a gifted natural good-sleeper.  I certainly envy parents of those children, but for us sleep has been an ongoing struggle.  We didn’t know what we were doing, and Xander can seriously fight going to sleep.  I like having a schedule, so being tied to the sleep and nutritional needs of a baby is challenging for me.  I like planning out my day, but nowadays I can make plans that get thrown off by an unusually short naptime or various other things.  Flexibility has not been my strength, and I am now constantly forced to practice it.  

Speaking of weaknesses, I have heard it said that part of marriage is that your spouse holds up a mirror to show you all your faults and sinfulness.  I suppose it’s not surprising at all, but I’m definitely realizing how much more a child is capable of that helpful and unpleasant task. I have had to face that I am not nearly as patient or selfless as I ought to be.

Our little guy is growing and getting chubby and I feel accomplished – I did that (sort of)!  My body is making milk that’s feeding him everything he needs, and it’s amazing.  At various points, it has seemed to us that he is just tired and can’t possibly be still hungry, but then he is only satisfied when he is fed, and we realize he is going through a growth spurt, eating more frequently for that 24-48 hour period.  I have often felt as though I am nursing him too much, but it’s not as though we don’t try other things first.  We can try to put him to sleep or use a pacifier, or motion, or whatever, but if he is hungry, he is hungry.  I found a great article that helped me relax about nursing him (“breastfeeding on demand” as it’s known).  When I realized that we had been ignoring his cues because “experts” (or really, just other people) made us think that he “shouldn’t” be eating so often, I felt bad.  I realized that we are his parents and we know him better than anyone else, and we really can tell when he is communicating that he’s hungry.  I have had to learn to trust those instincts.  

I guess you never know what kind of parent you will be until you are one. I always looked down on the attachment parenting movement (characterized by cosleeping, breastfeeding on demand, babywearing, and sometimes extended breastfeeding) a bit.  Mostly, I disliked how outspoken they tended to be in believing theirs was the best parenting philosophy, and how long some parents continue to do these things.  Personally, if my kid is still cosleeping with us at age 3, we may never have any other children.  I find myself landing in that general vicinity of parenting philosophies, though, and for awhile, I felt like a huge hypocrite.  Essentially, I decided I’m okay with the whole attachment parenting philosophy, at least with an infant, and when not taken to the extreme.  Regardless of what parenting style you end up using, no one should be snooty about their way being the best or only way.  Every parent/family is going to do what seems best and right for their family and that particular child, and none of us need any added pressure. 

I have found myself thinking that I would really like a day off.  I thought, “I have been doing this (nursing, not sleeping, changing diapers, trying to get him to sleep) for six weeks now, so it’s time for a break, right?”  I wish I could have one of the nights I used to enjoy so much – staying up all night long and sewing and watching Netflix and having eight hours to myself to do whatever I’d like. Oh yeah, and then sleeping like a rock for 8 hours with the bed all to myself.  It really is hard to believe that I have spent every day of this little person’s life with him.  I have spent more time with him than any other person on the planet.  Not even my husband has spent as much time with him as I have.  Crazy. 

Somehow, the days go by fairly quickly and yet still slowly at times.  I am kept busy, so the day doesn’t drag, but I spend a lot of time at home not doing anything visibly or measurably productive.  I am also an extrovert, which means spending this much time at home without seeing people drives me a little crazy.  I spend way too much time on Facebook to make up for not feeling connected with the world.  I really appreciate having both sets of grandparents and so many family members and friends in the area who are willing to come help me out, or even just come keep me company.  I don’t think I’m cut out to be a long-term, every day stay at home mom.  I’m grateful that Andrew and I have decided that when I go back to work full time (which as a nurse is just three days a week), he will drop to part-time hours and be a stay at home dad for part of the week, and maybe in a few years, be home full time. 

One of the most amazing things about motherhood is how much this child can frustrate and wear you out, and you still have the most astounding depths of love for them.  More and more people these days will say that they love their child(ren) more than their spouse, but I don’t think it’s fair to compare the two at all.  I love my husband, but the love I have for my son is just different.  I have definitely fallen in love with my son – the same moments of overwhelming emotional love that happened when Andrew and I were first falling in love are happening now, with Xander.  I could have just finished getting him to sleep (with great effort), and you would think I would be thrilled to be able to set him down and have some “me time” or get something done, but at that moment, I just want to hold him and stare at him and marvel at this little person that grew inside me and is ours.  His father and I feel incredibly blessed to have him in our family; I can’t imagine our lives without him.  To God be the glory!

"So I Nursed Him Every 45 Minutes"

"How American parenting is killing the American marriage"

Tuesday, October 14, 2014

On My C-Section Birth Experience

     My son’s birth was not at all how I’d pictured it.  Early in my pregnancy, I had decided I wanted a natural childbirth experience, a home birth with a midwife.  I saw a midwifery group for all my prenatal visits, didn’t have all the now-usual ultrasounds and testing and interventions, and was on track to deliver my baby in the comfort and privacy of my own home.  Well, that didn’t happen.  I had some preterm contractions at 30, 35, and 37 weeks, but primarily the problem was that Xander never turned.  For those of you who may not know, babies are usually supposed to turn head down by 35 weeks or so, and certainly before birth in the vast majority of cases.  Xander was stuck head-up, with his feet up by his head, which is known as frank breech position.  Although there are some practitioners who will perform a vaginal breech delivery, my midwives are not among them, so at 36 weeks I was transferred to the care of an OB-GYN, and began planning to have a Caesarean section.  Meanwhile, I did nearly everything in my power to encourage the baby to turn, to no avail.  I am very grateful for my doctor, and was especially glad that he was as evidence-based in his practice and supportive of me as he was.  I wanted the baby to come in his own timing, so I wanted to schedule my C-section later rather than earlier, and we decided to schedule it for right when I turned 39 weeks.

     At 38 weeks and 2 days, or about two weeks before my original due date, I went into labor.  I had had the regular contractions before, but this time I knew if we waited a little, I would have cervical changes and it would be considered real labor.  I tracked my contractions for several hours on Sunday night, and then went to bed for a couple of hours.  By 3 am, they had gone from slightly uncomfortable to “oh wow these are legit contractions now!”  So, by 5 am we were at the hospital, ready to have our baby!  I was monitored, and given terbutaline (again) to stop my contractions to allow time for the OR team to arrive and set up.  Because the contractions were stronger (and more painful) than the other times I’d had it, it didn’t work 100%.  I wryly commented to my husband Andrew while we were in the labor evaluation room how very far this scenario was from what I’d originally wanted.  I had envisioned laboring at home, in a peaceful and calm environment, with a midwife who checked on my status occasionally but mostly watched from a small distance.  Instead, I lay in a hospital bed, with monitors, an IV, and a catheter, at one point receiving oxygen by mask, waiting to be rolled into a surgical birth.  I knew it was necessary for my baby’s safety, but that didn’t mean I was thrilled to do it that way.

     In the OR, I received my spinal block and laid down.  I hadn’t realized how much sensation you retain with a spinal.  I could feel the scrubbing of the prep solution on my belly, and later the internal pressure as the surgical team delivered the baby, but no pain; it was very strange.  I was dizzy the whole time from the anesthesia, and unfortunately, I became nauseated right after Xander was born.  I had really wanted to start skin-to-skin time in the OR, to avoid even the delay until we got to the recovery room, and my doctor was very supportive of this idea.  When my son was born, they brought him over to me, and we started to do skin-to-skin, but I could only do it for a minute or two before my nausea became overwhelming.  At that point, my anesthesiologist gave me Benadryl (he had already given me the anti-nausea med Zofran), which pretty much knocked me out.
That was one of the main things I wish had been different about that day, because I felt like I missed out on the first bonding time.  I know that my husband and my son and I spent an hour in the recovery room, and I know we did skin-to-skin then and that my son probably benefited from it, but I felt like we were only there five minutes, because of how little I was aware of it at the time and what I remember of that time now.  I felt like I missed out on that first period of alertness that my son had after he was born.  I even asked my husband later if he had been alert, because I didn’t remember it at all.

     After that hour, I was rolled to my room on the floor, where both sets of new grandparents were waiting.  Throughout the course of the day, everyone in our immediate families and a couple of friends visited.  I’m grateful it worked out for everyone to be there; I know it meant a lot to them to meet Xander the first day.  Most of the day was a bit of a blur to me.  I continued to deal with dizziness and nausea, so I tried not to spend too much time with my eyes open or move my head too quickly, but I still got sick four times that day.  Looking back at photos from that day, I can’t get over how pale I looked.  By the evening, I was finally able to keep some liquids down, and keep my eyes open longer without excessive nausea.  After visiting hours ended, we had the first time alone as the three of us during which I was truly aware.  I think it was around that time that I felt like it began to sink in that our son had arrived.  All day long I had felt emotionally numb, and it had mostly seemed like I was holding someone else’s baby.  I think the nature of a C-section, as well as the drugs I’d received, facilitated this mental disconnect.  When I had time and mental energy to reflect on it, it struck me as so odd how I had walked into a room pregnant, and from behind a curtain came a baby, who was ours.     

     It never occurred to me before that a C-section birth could be such a different emotional experience than a vaginal birth.  In basically all the videos of birth and live births (both vaginal and C-sections) that I’d seen, there was a moment right after the baby’s arrival when the new mom met her baby for the first time – it was usually with tears of joy, exclamations of “our baby!” and always with an expression of a deep emotional response.  When I was planning a vaginal delivery, I so looked forward to that moment, and the pleasant rush of hormones that accompanies a natural birth.  Once we knew we were having a C-section, I knew I wouldn’t get that natural high from hormones, but I still expected that joyous time of realization that my baby had arrived.  I don’t think I ever had that moment.  Laying on the operating table, hearing my baby cry for the first time, I knew that was my baby crying, and I wanted to see him and hold him, but I was incredibly devoid of emotions at the same time.  It was like I wanted to have all the right emotional responses, but they just wouldn’t come.  I understood that a C-section would be a different physical experience, especially in terms of a longer and differently-challenging recovery, but I didn’t think it would be so vastly different emotionally.

     Thankfully, I had started to bond with Xander while he was inside me, and I was already determined to bond with him more and establish a breastfeeding relationship.  I do wonder how much more effort it might have taken to bond with him, though, had I not previously done so and decided to do so.

     Now, it’s been two and a half weeks since I was sent home from the hospital, and physically, I’m doing quite well.  For the first two weeks of Xander’s life, I felt like I had an unexpected amount of energy and was coping exceptionally well with sleep deprivation.  I don’t know if my body just reached its limit or if it was the other night when Xander’s sleep came in chunks less than two hours each, but that energy is gone.  Still, I’m able to do more than I expected to be able to at this point.  I walked up the stairs to our apartment by myself (without too much difficulty, even) the first day we got home, four days after his birth.  We made it to church on that first Sunday, just six days after the C-section.  I’m able to sit up pretty easily now, though I still use a bit of leverage (the crib next to our bed).  The pain from my incision and the surrounding area has been almost nil for awhile now.  Engorgement (when my milk came in) and the migraines I’ve been dealing with have both been much more problematic.  

     Actually, I knew ahead of time that migraines would be an issue for me postpartum, so I went out on a bit of a limb and encapsulated my placenta.  I had heard that the placenta has varied benefits such as helping with milk supply, moodiness, and other hormone-change related problems, and I’d hoped that taking the capsules would help prevent or lessen the migraines.  That has not seemed to be the case since I’ve had eight migraines in the two weeks since we’ve been home.  I haven’t had any problems with moodiness at all, though, and my milk supply has been great, so it’s possible they are still helpful.  Hopefully, the migraines will ease off over the next couple of weeks.

     In my next post, I plan to reflect on new motherhood.  For now, I’m off to try to catch some more sleep.