Thursday, May 8, 2014

On Obstetric Care and the Traditional Medical Model vs Midwifery and Alternative Medicine

 *Note: I don't even consider midwifery care under certified nurse-midwives with master's degrees and licenses actually very "alternative" as far as alternative medicine goes, but that's how the establishment of medicine as a whole (and insurance companies, particularly) see it, so that's how it must function.

     Fair warning: this post is going to be a longer one.  This week, I went in for our first OB/GYN appointment, at 18 weeks pregnant, because I want to do an ultrasound and get it covered by insurance.  I could get a referral to a radiology group from my midwives group, and pay out of pocket, but I thought I'd try to save us $150.  So here I am, a regular person with decent (not spectacular) insurance, seeing an OB while pregnant, paying a reasonable co-pay... what an experience.  I knew as soon as we walked out of the office that I had to write about this experience, because it was so drastically different from my experiences so far at my midwife. 
[Full disclosure: my doctor's office will remain anonymous because I didn't see the actual OB.  I will, however, tell you that I have been seeing and plan to have a home birth with South Coast Midwifery, which came highly recommended.]

     First of all, the reason I was connected to this OB/GYN’s office is that I called my insurance to get a list of doctors, and was told that I had already received authorization to see this doctor, whose name was long but started with a W.  I figured I’d be happy to save the time and effort getting authorization for another doctor, and just called that office to make an appointment with Dr. W.  When I spoke to the office staff, I made the appointment, and asked if we would do an ultrasound as part of the office visit, and I was told we would.  I was thrilled to have an appointment for Monday in which Andrew and I might be able to see the baby and even find out the gender, even though I had been ready to wait another two weeks to get an appointment to do so.

     When we arrived at the office, I didn’t see Dr. W’s name on the list of doctors there, but it said Women’s Clinic so I figured we were probably in the right place. I went to sign in, and asked if this was Dr. W’s office, just to make sure.  The office staff told me that Dr. W had retired over a year ago.  I found out after about ten minutes that my insurance had authorized me to see any clinician in that group and that I had an appointment there, but obviously not with Dr. W.  I told them I was fine to see a nurse-practitioner that day, since they gave me the option. I was confused why no one told me on the phone that I wouldn’t actually be seeing Dr. W for my appointment, but I let it go.  They called me back after we’d been there about 15-20 minutes, took my vitals, and started asking me basic history questions.  The medical assistant took us back to an office to ask questions about my medical history (strangely we never filled out the typical medical history form). We spent the majority of our time with her, and even though I had mentioned that I’d been seeing a midwife group for prenatal visits, she rattled off all the information about delivery, “Your doctor is Dr. A---, he delivers at these three hospitals, but you don’t get to choose, your insurance decides it.”  She also recited their office policy on bringing children to the office, and then asked if this was our first pregnancy.  Eventually she led us to an exam room, and said the nurse-practitioner would be in soon, so I should go ahead and get in a paper gown, which was actually a paper vest and large square paper for the lower half of my body.  Fun times. 

     When the nurse-practitioner came in, she muttered her name so quickly that I didn’t catch it, faced the computer for a moment, and then jumped right into the physical exam, followed by a pap smear.  That procedure was assisted by a random staff member who walked in and out without saying a word.  The nurse-practitioner checked the baby with fetal Doppler for about 10 seconds, and was done with me in less than 5 minutes, at the end of which time they told us we weren’t going to do an ultrasound today. 

     Here are my problems with this experience.  I was not only frustrated at times by this appointment, but I was appalled at the complete lack of concern for any human experience in it, or even a simple concern for “patient satisfaction”. 

-          We were there for over an hour and a half, and spent a total of less than five minutes with the actual clinician.  Everything was extremely assembly-line-efficient, at the expense of any human or caring touch.  I met the nurse-practitioner for the first time with my clothes already off (I was glad she was at least female). 
-          No one used my name other than to call me to the desk and then back to get started.
-          No one acknowledged Andrew’s presence except when the medical assistant asked me if I was married and then if he was my emergency contact.  The nurse-practitioner made a comment about/to Andrew because he had sat behind me to keep me warm while we waited for her to come in, and then proceeded to passive-aggressively and non-verbally push him out of her space. 
-          I felt lied to, because I had specifically asked and been told that ultrasound was a part of the appointment, only to find out at the end that they weren’t going to do one. 
-          There was NO education whatsoever.  The only questions they asked about the pregnancy mentioned morning sickness and bleeding, but there was no discussion of what’s normal and what isn’t with regards to symptoms like ligament pain, or when to expect to feel movement.  There was no discussion at all about nutrition during pregnancy, except to ask if I was taking a prenatal vitamin (which isn’t all you need, in case that’s not obvious).
-          There was absolutely no recognition of the emotional side to pregnancy, except a half-hearted “congratulations” from the medical assistant.  There was no acknowledgement of an emotional response to hearing the baby’s heartbeat, for what could have been the first time for all they knew.
-          Some office staff had literally no idea what I meant when I told them I am seeing a midwife group for my prenatal care and didn’t need to see the doctor again.

     See, my midwife group doesn’t have to do much to be leaps and bounds above my experience at the OB/GYN.  They don’t need to be nicely decorated, or have very comfortable rooms, or make sure that you meet all the midwives at your various prenatal appointments so that you know whoever it is that ends up delivering your baby.  They just need to be human, and treat you like a person.  All the rest of those things are just icing on the cake, because by simply acknowledging that pregnancy is an emotional and personally meaningful experience, by using your name and customizing care to you as a person, they have already succeeded where we in the traditional medical model are apparently failing. Andrew and I said to each other several times while in the appointment, and more so afterwards, “This is why we’re going to a midwife!”, but I can’t help but think about all the people who don’t have that option.

     Firstly, there are all the millions of women who don’t even know that they have choices about where and how they deliver their babies, or who don’t know they should be utterly unsatisfied with mediocre care and no prenatal education, with no personal caring.  Additionally, there are plenty of families for whom choosing something other than what is covered by insurance is simply not an option financially.  Of course, I know that not all OB/GYN offices provide the kind of experience I had; perhaps it was because the Women’s Clinic group I saw primarily serves cheaper insurances and low-income women.  Does that make it any more acceptable?  Of course not!  In fact, it’s more maddening to me, because of all the women who need good prenatal care, with education about what to expect, and what kind of nutrition they need, it’s low-income women!  The fact that certain populations (i.e. upper middle class and upper class) can afford to educate themselves with birthing classes and receive better prenatal care by going to their first choice of OB/GYN or choosing to see a midwife does not solve the problems of the traditional medical model of obstetric care.  Sadly, all it does is widen the gap of health care from one end of the spectrum of income to the other.

     How do we fix this?  How do we move away from the assembly-line model of care for pregnancy and birth, in OB/GYN offices and hospitals? How do we improve our absolutely terrible rates of maternal death and complication, preterm birth, and our sky-high rates of C-sections? How do we reduce the costs of healthcare as a whole and of pregnancy-related hospitalizations specifically?  Obviously, there are no easy, one-quick-fix answers to any of these issues.  That certainly doesn’t mean that there are no answers.  I think we start by encouraging women from every walk of life to educate themselves, through free classes offered by hospitals, information available at public libraries, and reputable websites.  Insurance companies would do well to cover midwifery care under licensed midwives for low-risk pregnancies, which are in fact most pregnancies.  The majority of births should be pushed out of the typical hospital setting and back into the home, or the birthing center, and birthing centers attached to hospitals.  Women and their partners in the birth process should be thoroughly educated about the real risks and complications of epidurals, C-sections, and every other intervention that is used in delivery, and never manipulated by any clinician.  Doctors should be trained with at least 75% normal deliveries, and see at least a handful of births with no medical interventions at all, including those in non-traditional positions.  All health care staff who work with laboring women need to evaluate their expectations for the length of time labor and deliver should last, and make sure that they’re realistic, and not merely ‘by the book’.  These changes would make for a good start in the right direction.

     Although I have personally chosen to have my prenatal care and delivery with a midwife, I strongly identify with the traditional medical care system, and I know we can do better.  We have a duty to our patients to do better with our care, because we should care and remember they are people first.  We have an obligation as a country to do better with the cost of health care, because our debts and spending are out of control.  We have a responsibility as an example to the world to do better, because we are a first-world country with third-world rates and stats. 

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Want to educate yourself? Here's a great place to start: http://chriskresser.com/naturalchildbirth


Wednesday, May 7, 2014

On Healthcare & Technology

     This post may be on the intersection of healthcare and technology, but in a way it's just a portion of the way technology is used - social media. Otherwise, I could make this part one of many, and I'm not sure I want to do that just yet. This came up recently at work; a family member was trying to film some nurses doing their jobs while the family was in disagreement with or simply unsatisfied with the health care team about their loved one's care.

     Today I want to share some of my thoughts on why it can become an issue that technology is everywhere, and that so many people are trigger-happy with that "Share" button for social media.  These days, most healthcare facilities have several policies on the use of technology and social media, if not a person whose job that is, or even entire departments devoted to it.  Sometimes they cover the public relations for the facility, and most of the policies relate to how staff members are expected to appropriately use technology/social media, but some are focused on how members of the public can use technology and social media while in that facility.  For example, I have heard of a hospital where the staff is instructed to not allow family members to film the birth of their child, because it's against the policy.  I think that's an extreme end of the spectrum, but let me explain some of what our thinking is (members of the health care team, that is).

     First, and the biggest concern for hospitals, is that the use of technology and social media in patient care areas is a major threat to patient privacy, which is protected by federal laws, and enforced with hefty fines against the facility. It doesn't matter if the hospital has no idea that the relatives of the patient next door to you take a picture that has your name and room number in the background, or you for that matter, and post it online, it's considered the hospital's breach of HIPAA laws and the facility pays the price.  The fact that technology is everywhere means that we have hardly any control over this happening, so if we do see it, we don't allow it.  

     Now what if you want to take a video of me while I'm doing my job, whatever the motivation?  I personally wouldn't let you film me doing my job, for several reasons, whether or not my facility has a policy against doing so.  Primarily my concern in that situation is quality of care.  I don't need to deal with the distraction when I'm in the middle of a code blue, or any situation that may arise in ICU (or elsewhere).  This use of technology is very distracting, and cannot simply be ignored, because of a few problems.  One, if you are not 100% satisfied with my care, or your doctor's care, etc,  you can put me and my facility in the court of public opinion by posting a video online, rather than through normal channels of making a formal complaint, that goes to people that hear both sides, and know all the facts and variables.  This is especially true because anyone can edit a video to show only what they want to show!  I could easily lose my job and risk losing my license because of someone's vendetta -- like I said, public relations, which sometimes necessitates that the facility take action so they look like they're doing something about a situation, even if the person getting fired is really a scapegoat.  The second problem is a more personal one: I have no control over my personal privacy if you take a video of me and post it online.  I personally am fairly cautious about what I post online, and am extremely guarded about what I own up to by attaching my own name (searchable by future employers, to say the least). If you take a video of me, and list my name (even if it's a generally positive video!) I still have no control over it.

     Thankfully, this issue doesn't come up terribly often for me, but in some areas of medicine/nursing it comes up frequently. One of those areas is, of course, labor and delivery, where people want to film their births. I think this should generally be an exception to the facility's rules about video/photos, because it's a very special moment in a family, and not merely a medical issue.  I can, however, completely understand why a facility would want to cover themselves by outlawing even that.  If something goes wrong during the birth, you have proof that you can manipulate through editing to say whatever you want when you go to sue the doctor and/or facility.  The reality is, you as the patient chose to give birth at that hospital, and by doing so must abide by their policies.  You have options (usually).

     Like I said, I think there should be exceptions to these policies. I am fine with photos and video as long as they are in the patient's room (and it's a private room) so that no other patient's privacy is infringed upon, and as long as they are patient-focused.  I would allow and even encourage recording video messages or taking photos/videos of a person who was dying, for example.  The main difficulty is that hospitals have an easier time enforcing an across-the-board, this-is-never-allowed sort of policy than any policy that involves exceptions for certain circumstances. Just look at visiting hours policies to see proof of that!

Monday, July 15, 2013

On Debts


       When we moved back to California, I thought I had things pretty well together for our move.  Everything was organized long before we picked up the moving truck, we packed things thoughtfully, such as an "unpack first" box with basic essentials, and I left our new address and contact information with our apartment office.  Recently, my husband lost his wallet and we realized that if some helpful stranger found it and mailed it to the address on his driver license, it would go to Mississippi and we'd never see it.  My dad informed me that you can forward your mail through the post office, which I had not known. 

      I set up mail forwarding, but didn't expect to receive anything more important than catalogues.  After all, I had changed my address for everything I could think of -- all my student loan lenders, credit card, the Board of Nursing, etc.  I was a bit surprised, therefore, to see forwarded mail arrive from my old hospital.  When I opened it, I was very unpleasantly surprised to see a medical bill from an ER visit back in the fall.  "Account Past Due" jumped out at me from the page, and the balance of more than $4000 made my jaw drop. 

      At that moment, I was in a whirlwind of emotions.  I was shocked, to be sure, because I had insurance, and had never seen an explanation of benefits that would explain that amount.  I was angry, at myself for not knowing about mail forwarding before and not thinking of asking someone who might know.  I was in disbelief, because I had no idea how I could owe that much on one ER visit.   I was immediately anxious, because we don't really have $ 4000 sitting around, but we've been budgeting and saving up for and dreaming about finally making a trip to Disney World this year, and my dream felt threatened.  I was worried.

      I forced myself to set all this aside, because I had to work that night.  Over and over, throughout my shift, my worries kept coming back to me, and I ignored the pit in my stomach, knowing I couldn't do anything until business hours in Mississippi.  The only thing I could even think to pray was simply, "Please, God, don't let this be real."  When I got home that morning, I dreaded making the phone call that might confirm that I owed them $ 4000, and that would decimate our hopes for a dream vacation.  I called my mom, grasping for consolation, and that helped a little.

      I pulled myself together to make the phone call, utterly miserable, and gave the friendly woman my account information.  She retrieved my account and I waited for the dreaded confirmation.  She then cheerfully informed me, "I'm showing that you owe nothing."  I think I wanted to cry from the relief of my anxiety.  After having her double check, I hung up and just sat on the couch, stunned.

      I know for many people, four thousand dollars isn't that much debt, perhaps isn't that intimidating.  To me, though, it was so much weight added to my already heavy burden of debt.  I have quite a few loans from school I'm trying to pay off, and it seems to be making such slow progress.  I would love to buy a new car (we only have one), among other things, but I refuse to go further into debt at this point.

      Although nerve-wracking, this experience has been such a good object lesson reminder for me.  My emotional state at the thought of more burdensome debt paralleled that of sinners drowning in unforgiven sin and the heavy weight of that debt.  My small but intimidating debt being simply gone reminded me of how it feels to know that Jesus has paid for all our debts.  "Paid in Full" instead of "Account Past Due" and remaining balances.  I was grateful to God for his Providence in our situation, but I am immeasurably grateful for his Sacrifice for all sinners.  What an excellent reminder of how much grace we have to be thankful for as believers, completely forgiven of the debt of sin by a merciful God.  Praise be to God, his love endures forever.

Tuesday, June 11, 2013

On Power

      When I was in nursing school, I had the privilege and opportunity to visit a client during our home health rotation that made a long lasting impact on my life.  This particular client was a former nurse with a rare, debilitating, chronic disease that had nearly taken her life on several occasions, and which left her bedbound, on a breathing support machine via tracheostomy.  For simplicity's sake, we'll call her "Nicole".  Although the tracheostomy limited her communication somewhat, she made it a point to impress upon my classmate and me a few key lessons during our brief visit.  Those lessons have stuck with me, even to now, three years later.  One thing she told us was to always remember that it could be one of us in her place, as the patient, and her in our place, but for the grace of God.  That was powerful to hear, and important to think about.  We should never treat our patients differently as people simply because God's plans for our lives led us to opposite sides of the bed rail. 

      The second point she made was also impactful, and closely connected to the first.  She told us that we healthcare providers easily get in the habit of unconsciously assuming that we have the power in our interactions with patients.  We come barging into their rooms without knocking, telling, not asking, patients to take their medications, or have a test done, or take off their clothes.  It's probably borne out of our intentions to help, combined with the idea that we know better than the patient what they need to do to get better, along with the urgent nature of our busy, demanding jobs.  Still, Nicole wanted us to realize that we hold most, if not all, of the power in our interactions with patients, and we need to remember to give some of it back to our patients whenever possible.  We need to knock first, ask for permission, listen to them, treat them with respect for the people they are, and give them choices as often as we possibly can.  In some cases, it may be that we can only give them a choice between taking their meds with juice or water, but once we start working with the right perspective, we may realize many more opportunities for patient choices arise.  In home health, this is even more important to remember, because you're on their turf.  It would be incredibly rude to come into someone else's home and start bossing them around, acting like they should listen to everything you say only because you're the nurse, without also giving them respect as a person.


      I was reminded of these lessons recently because I took a shift with my old in-home care agency -- my first since moving back to California -- and it was a struggle.  I expected to have difficulty with the wrong things.  Yes, it's harder to stay awake and not be bored when you're sitting in quiet darkness with no one to talk to and far less walking than my usual job.  Yes, it can be hard to remember that I can't do all my usual nursing responsibilities when I'm functioning as a personal care assistant.  What I didn't realize would be the biggest struggle was this shift in power.  In that home, I was not in power.  My usual reasons to do things my way or in my timing didn't apply because my client is on hospice.  I wasn't there to make him better, I was there to make him comfortable.  Since no one but the patient can determine if he's comfortable, it wasn't up to me.  I didn't have any reason to push him to take the meds I know would help his pain or itchiness, because it was 100% his choice.  You may think (or rather hope) that this would not be so very different from my usual job, but in most hospitals, it absolutely is. 


      Patients in hospitals have autonomy, but unfortunately most of the time that power of choice is more theoretical than literal.  If a patient declines a medication, the nurse may try to change his or her mind at the least, and he or she risks it affecting the rest of that nurse's care of him or her at the most if that nurse acts miffed about it.  I had a patient tell me last week that at another hospital, she was handed a stack of forms and told to sign them.  This is fairly standard, but what was not standard was that when she paused to read what she was signing, the nurse basically told her she didn't need to read it, just sign, and then took the papers away and documented that the patient had refused to sign them.  Now, it's not that we don't have good reasons for doing things a certain way, at least some of the time; if I try to change a patient's mind about taking a medication, it's most likely because I know it's important and not taking it could be detrimental to their health.  However, we undoubtedly cross the line, and take this unbalanced power situation for granted.


      It's an unfortunate situation that medical professionals have become accustomed to holding all the power, and using it thoughtlessly, rarely giving any power to the patient.  We need to remember that our patients are people, with autonomy and deserving of respect.  We need to look for opportunities to put the power back in patients' hands, with little decisions and big ones.  We need to remember that our situations could easily be reversed, but for the grace of God.  Last night's in-home care shift was a good reminder to check myself, examine my own habits, and change what needs to change.

Saturday, April 13, 2013

The Move Back



      I’m having a hard time believing we’re already well into April, and that we’ve lived in this apartment, and in California, for two months tomorrow.  The time has flown by, between  the initial unpacking, adjusting to my new job and new schedule, and reuniting with family and friends.  I’ve been meaning to post about my new nursing job for awhile now, but I have difficulty sitting down to write when I don’t have more than one to two days off together, and almost none of them completely free.  I got spoiled by my old schedule of seven-on, seven-off (yes, twelve-hour nights) that it’s more of an adjustment than I expected to try to get things done on only a couple days off in a row.  I suppose that’s for the best, though, since I am now better able to discuss the differences between my old job and the new, having finished orientation and switched to nights – finally!

      I know, some people want to feel bad for me, thinking I’ve been stuck working nights, but actually, I prefer them by far.  Nights are quieter, more laid back, with less people around in general, and certainly less people whose company I don’t miss: doctors, administrators, visitors.  Not that I dislike them, exactly, but… well, I’m sure you get the idea.  More importantly, we have fewer transfers, fewer procedures both at bedside and away (CT, etc), and all of that means I am not so crazy busy.  All of this is pretty much true everywhere.  Now to compare my new job and my old one…

      The first thing that always comes to mind when I talk about my old job versus my new one is the computer charting system.  I really disliked Cerner, and my coworkers and I had a laundry list of things wrong with it (or that we could’ve designed better), and I thought when I left Mississippi that it had to be the worst, most basic, cheapest one on the market, so I couldn’t wait to use the new one at my facility in California.  I don’t think I have ever been more wrong.  I disliked Cerner, but now I would go back to it in a heartbeat!  Not just because I dislike change, mind you, but because CPSI absolutely is the worst, most basic, cheapest EMR system on the market.  I have learned the system now, which didn’t take long since it’s a glorified Excel file, and I still hate it.  You might think this is not that much of a deal breaker, since it’s just the computer system, but you have to understand that that’s like saying it isn’t that bad that your cubicle’s only two feet by two feet.  The computer system we nurses use can really help us – save us time and effort, make lab results and meds easy to find – or it can really frustrate and limit us – make us enter vital signs manually, run slowly, make things take twenty clicks to get to.  Alright, rant over.

      That’s the major difference, and major negative for my current hospital.  On the whole, though, I otherwise like my facility pretty well.  It doesn’t strike me as hugely different than my old facility; the patients are a similar level of acuity, we don’t do trauma, and we’re not a teaching hospital (no residents).  The people I work with are generally cool, helpful, and friendly.  I like having an Omnicell for supplies (charges patients for items as you pull them out) versus having to manually charge for items, usually at the end of my shift.  It’s larger than my old facility, but the area I work in doesn’t force me to go to lots of other areas all the time, so while I’m basically useless if visitors ask me for directions, I’m not too overwhelmed.  There are many more doctors here (I could probably name all the doctors I’d commonly work with in Mississippi on both hands), but thankfully at night I mostly interact with them over the phone, so I’m not expected to recognize everyone. 

      I had a more than adequate orientation period, so I feel like I have the routine down well, and I certainly still have plenty of resources for my questions.  Although the patient acuity level is similar, I’ve still gotten to see new things, and I know I will have the chance to see more new things.  I’m excited to broaden my experience and continue to grow my skills as a nurse.

      Otherwise, things in my life have been much the same as in Mississippi, though we are thrilled to see family and friends here again.  We have a long list of fun things to do, some to make up for things we missed in MS (the beach, the OC fair, the Getty) and some cool new places we've heard about like new restaurants and things.  We'll see how quickly our budget allows us to check out all these new places, though.   


      That has been an adjustment, too, the financial differences between here and Greenville.  Funds are tighter, at least til Andrew starts his job.  He got rehired at Disneyland!  We're excited for his benefits to kick in so we can go to the new Cars Land, Ghiradelli Factory (though we'll miss those tasty fresh tortillas from when it was the Tortilla Factory!) and see the amazing shows World of Color and Fantasmic again.

      We love our new apartment, and new city.  We downsized, so I'm still working on getting rid of a couple of boxes, but I love that our unit is situated in our complex so that we have a barbecue, laundry center, and best of all, jacuzzi, within sight of our apartment!  I've already gotten plenty of use out of the jacuzzi -- I think I went nearly every night after work when I was orienting on day shift!  Now that we got our couch from IKEA (which I've had my eye on for nearly 2 years), we've really enjoyed having people over for dinner and swimming.  Andrew loves that we live so close to downtown Brea, and keeps bugging me to go walk down there to dinner sometime.  I think he has a misperception of how close it actually is, but we'll go to dinner and movie and maybe the farmers' market sometime soon.  Brea is a lovely area, and I like having so many of my favorite places so convenient: Target, Souplantation, Old Navy, several grocery stores, and the regular and discount movie theaters!


      All in all, we're settling in nicely here, and happy to be back.  Greenville was exactly where God wanted us for the last year, and we are so glad we met so many people we love there, and grateful for the lessons we learned while we were away from our network of family and friends for our first year of marriage.  We will never regret moving to Mississippi; it was our little adventure as newlyweds, but we are also very happy that God provided for us to move back home.

Saturday, October 20, 2012

Doing Our Due Diligence: Part 2

     If you are just joining me, you may want to read this introductory post to better understand where I'm coming from before reading this one.

     The topic I want to address today is a subject that has managed to polarize most of the country, one that many people have very strong opinions about, and which has even led to extreme reactions including violence: abortion.  This post will probably not manage to sum up the entirety of my thoughts on the subject, and I am certainly open to further civil discussion.  I can guarantee that not everyone who reads this will agree with me, but that is likely true of every issue.  I simply want to articulate in writing where I stand, in part for my own benefit as I verbally process my thoughts.  It has certainly become an important issue in this upcoming election, so I think this is timely.

     I was prompted to write about this issue by several things, and this post has been a work in progress for some time now.  First, I had strong feelings about this photo, seen on Facebook.


     This photo, and the Facebook page that generated it, distinguishes between "pro-life" and "abolitionism", which I thought was a helpful and significant distinction.  More on that in a bit.

    Another motivating factor for me was this article about congressman Joe Walsh's recent statement: http://www.npr.org/blogs/thetwo-way/2012/10/19/163239925/life-of-the-mother-never-a-reason-for-abortion-congressman-says

     That article is the second example lately of idiotic foot-in-mouth moments, unfortunately by Republicans, regarding abortion. The previous instance, referenced in the article, was Todd Akin's statement that a woman couldn't get pregnant if she were "legitimately" raped.  First of all, let us be clear that both these men are (at best) ill-informed, because there absolutely are cases of pregnancy from rape, and there absolutely are risks involved with pregnancy today, in this country, despite all our advances.  Setting aside their inaccuracies, the bottom line is that both men are trying to be pro-life without exception, right?  Neither one wants to allow any reason for abortion to continue to be legal.  Well, I have a problem with that.

     The photo above differentiated between being "pro-life" and being an "abolitionist".  It also implies that abolitionism is the only possible moral action one can take when one's moral opinion is pro-life.  I am 100% unapologetically pro-life.  I am not, however, an abolitionist.  I believe life is sacred, and all life has value, and I therefore believe that I cannot in good conscience support making abortion illegal without exception.

     Because I believe all human life is valuable and all lives should be protected, I believe the life of the mother has equal value to the life of the unborn child.  Abortion is the tragic loss of the life of an unborn baby, but if abortion was never an option, there are cases in which two lives would be tragically lost.  I believe abortion is evil, and when used without limits it is morally reprehensible, but I also believe it is a necessary evil in some instances.  Ectopic pregnancies, where the fetus is implanted outside the womb, will always or nearly always threaten the life of the mother, and the fetus cannot even survive that way.  There have been cases when a woman finds out she has cancer while she is pregnant, and although some bravely wait to have treatments until after they deliver, that is not always possible.  In that difficult situation, there is no easy answer.  I could come up with more examples, but the fact remains that this issue is not as simple as many people make it out to be.

     Secondly, because of the value of all life,
I do not want to revert to the era of seriously unsafe (read: fatal) abortions.  Before abortion was legal, far more women died of infections and botched abortions.  Don't get me wrong, and don't be deceived: they still do.  There are injuries and deaths of women every year because of abortions.  Making abortion illegal, however, is not actually going to eradicate them, and it's certainly not going to help make them safer.  I am a nurse, and as a medical professional I am privy to the fact that there are less than scrupulous medical professionals who do not document truthfully.  As such, it would be incredibly easy for abortions to continue if they are illegal, because some would simply not document them as what they are.

     Many Christians (perhaps the vast majority) are pro-life and/or do not support abortion.  I think it is likely that many of them have not thought it through extensively as far as what it means to be "pro-life", but that is beside the point.  There are many Christians who believe that we must fight against abortion, in part by working to make it illegal.  Yet, we are not here to Christianize the culture, we are here to share the good news of Jesus Christ.  Although our country was founded on Judeo-Christian values, it is not a Christian nation, and will never be God's chosen nation.  By trying to make abortion illegal, aren’t we at least partly relying on the government to change what people do, rather than recognizing God is far more effective at that since He changes how people think and what they value?  I strongly doubt that debates over “rights”, whether to personhood or control of one’s body, or the successful reversal of Roe V. Wade will change people’s hearts.  Arguments don’t change hearts, they merely address the issue intellectually and may even lead to hardened hearts.

     I do think that abortion is incredibly overused.
 I believe we as the medical community have failed women in a terrible way by allowing this to happen.  In part, this failure is due to our passing the buck to abortion clinics rather than maintaining a stricter control on abortions, and holding the procedures (and locations) to higher standards of safety and cleanliness, as well as performing honest academic studies on the effects of abortion on the body and particularly its impact on the psyche of a woman.  Regardless of what you think of abortion morally, everyone should acknowledge that this is a surgical procedure, and is not without risk of complications or death.  In fact, I guarantee that the clinics who perform abortions give their patients a waiver regarding these things.  I would fully support legislative changes limiting abortions so that they are not used as a form of birth control and not available to just anyone for any reason.  I’ll be the first to admit I don't know what those regulations would look like.  I do wonder what would happen if some of the people who work so hard to abolish abortion redirected their focus to that effort.  A smaller victory, yes, but I think it would be an effort in which the “pro-lifers” may find some surprising supporters and unlikely allies.

      So, if we Christians shouldn’t necessarily be putting so much of our efforts toward making abortion illegal, what should we do?
  Put our “money where our mouth is”.  I once read a comment online from a person who was “pro-choice” who asked something to the effect of, “Who would adopt all the babies put in the system after not being aborted? Would you?”.  It was clear from the tone and comment that this person expected that query to make a “pro-lifer” hesitate, but I mentally answered, “yes! I would!” without pause.  I believe that kind of thing is exactly what we Christians ought to be doing.  We should be standing outside abortion clinics, not yelling in protest, but available to talk, counsel, and deter women from having abortions by giving them other options.  Our efforts through crisis pregnancy centers and community involvement should be so excellent that all women who feel they cannot handle a pregnancy should know where they can go.  We should be lovingly supporting those women emotionally, financially, and providing a place to stay.  Then, once we’ve made an impact with our actions which speak louder than words, we can have the opportunity to share the gospel with them and support and counsel them spiritually.  That should be our goal and is our calling.  Yes, saving the lives of unborn babies is vital, but saving the souls of their mothers as well as giving them the chance for life is better by far.