And the winner is...ME!

3 years ago in June I had what seemed at the time to be a completely crazy idea. The process of preparing for medical school has been nearly as transformational as I imagine the actual experience will be. I cycled through many different life plans and ideas of what the next phase of my life would look like, I met new friends, learned a lot and had some pretty great adventures. 

But the last few years have also been some of the hardest in my life for other reasons - if you know me well enough to have my phone number, you are welcome to call me and find out the details of these problems. I'd consider it an opportunity to share more of myself with you, not you being nosy at all. For this forum, it will suffice to say that these problems have worn down my significant determination and left me tired of weathering storms and pushing through with sheer force of will. 

When I started this journey I only considered it initially because it was theoretically possible for me both to attend medical school and complete residency here in Oregon, where doing so would disrupt our lives the least. As things progressed I realized how competitive the process is and also tapped into my own ambition - what if I just did my best and went to the BEST school that would accept me? The focus also changed - medical school would be a way to get back East, back to my family, my chosen family and my dear ones who I have missed so much. This seemed like an opportunity to make that transition and I set my sights back East. 

But make plans and the Gods laugh, right? At the end of 3 harrowing years our prospects are looking up and things are looking good - right here in little old Portland. The idea of subjecting my self and my family to the known stresses of a cross country move (even to move *back* to a place we already know) gives me pause. It has taken some time, but we've built up a nice community for ourselves here, the kids have unique school opportunities, Tim has a fantastic job and we've managed other probems to the point that they are non-issues. It shocked me to realize as I was busy preparing myself to leave Oregon, I ended up making a pretty nice life here.

The med school application process is a long, drawn-out one - beginning for me in August (not counting the months of preparing my application to be ready for submission) and extending through this month. During it all, I have been humbled and amazed at the reaction from schools and my friends. There were a few disappointments - my top choice school rejected my application so quickly it would make your head spin, a program that I really liked on paper raised so many red flags during my interview I couldn't realistically consider it. But I was invited to interview at 6 schools and admitted to 5 of them. And my friends. Wow. The interest and enthusiasm and support have been overwhelming. I am really grateful for your likes and comments and support during this process. I am feeling the love! 

It turns out that figuring out which school is the "BEST" school is a trickier prospect than I anticipated. There are rankings and dollar signs, reputations and match results. But in the end the best advice was the first, most infuriating advice - find the school where you like the people the best, where you can best see yourself as a student, where you have the best "fit". (What is it supposed to mean? I think it is one of those things that only makes sense after you go through it. You just have to figure it out!)

Who I am and what I want to do with my medical career definitely fit best with one of the schools that admitted me - a school that values my unique, extended pathway toward medicine and shows it by admitting a lot of older students making career changes, a school that cares about physicians as healers and shows it by really teaching clinical skills and offering a lot of opportunities for and training in and evaluation of patient interaction, a school that supports academic medicine and research and has an excellent OB/GYN department (which offers water births, has a vaginal breech program, a strong nurse midwifery school and a head who is committed to cesarean reduction). This is not to say that this option is perfect - there are some down sides to picking this school - its facilities are not the newest and the curriculum is not systems- or problem-based learning. They have a graded scheme for the 1st and 2nd year instead of pass/no pass. It is far away from my family, chosen family and dear ones. 

Most of all, choosing this school demands that I choose whether or not I can abandon my preconceived notions of what medical school will look like, what it will offer me and how I will direct my life as a result of this process. In short, this choice demands that I relinquish control. Do I want to be the best doctor I can be or do I want things to work out the way I planned, the way I wanted? Do I just want to be right? For a couple of days now I've been carrying the decision around in my heart, seeing how it settled in. It seems to be doing just fine. 

All of this to say - In August I will be going to medical school at Oregon Health Sciences University, right here in Portland, OR. Isn't it funny how things turn out? 

This should be fairly obvious...

So it turns out, I'm not much of a blogger!

I do enjoy reading blogs though, and here are a few that I've become a fan of:

Cartoon Guide to Becoming a Doctor
Mothers in Medicine
Dr. Grumpy
Academic OB/GYN

I'm not going to take down the blog b/c a few of my posts have been linked to by others and I just don't want to.

Thanks for stopping by!

New VBAC recommendations from ACOG

In July 2004 the American College of Obstetricians and Gynecologists issued practice bulletin #54 - which changed the status quo for treatment of women with a history of prior cesarean.  The big change was that ACOG recommended that women attempting a vaginal birth after cesarean (VBAC) should labor with a "physician immediately available throughout active labor capable of monitoring labor and performing an emergency cesarean delivery."

The big word there was "immediately".  It appears exactly once in the practice bulletin but it is an important word.  It caused a string of practice changes for obstetricians, policy changes for hospitals and health outcome changes for pregnant women.  In short, the VBAC rate plummeted and hospitals demanded that women submit to surgery.

Yesterday, ACOG issued a new practice bulletin, #115, that they intend to replace the infamous bulletin #54.  This bulletin doesn't seem to remove the damning word (though I just read the press release, it costs $ to order the active bulletins).

This time the press release opens with, "Attempting a vaginal birth after cesarean (VBAC) is a safe and appropriate choice for most women who have had a prior cesarean delivery, including for some women who have had two previous cesareans"


But it also uses the word "immediately" three times.  And while ACOG acknowledges that women should not be forced to submit to surgery in hospitals that do not have "immediately available" staff, they are rather vague about what an acceptable plan for these facilities would be for women undergoing a trial of labor after cesarean.  


I appreciate the more nuanced understanding that ACOG has demonstrated with this new practice bulletin.  Maybe they are beginning to recognize the serious impact these statements have on the care women receive across our country.  I certainly hope so.


However, this is not a situation in which the organization can simply say "Our bad" and undo all the damage that has been done by bulletin #54.  It would be nice if we could just "withdraw from circulation" (see here) the fear and ingrained policies and the lack of access that #54 has visited upon American women.  


We know that women who have given birth by cesarean are less likely to choose or achieve another pregnancy and that their subsequent pregnancies are subject to greater risks.  We know that the more cesareans a woman has, the more dangerous it is.  We know that #54 increased the number of cesareans that were performed on women.  We know that #54 was a mistake, and now ACOG has admitted it.


But admitting a mistake and even rectifying that mistake with a nuanced and understanding new practice bulletin doesn't undo the damage of that mistake.  #115 isn't going to be able to undo all the havoc #54 has wrecked upon American maternity care.


 We need a comprehensive approach to cesarean reduction, we need consumer education, targeted interventions for women with prior cesarean, policy reviews at hospitals, practice standards for physicians (set by the physicians themselves, I'm not trying to tell anyone how to practice medicine) and we need public access to cesarean data so that consumers can make truly informed decisions.  


#115 is a nice start, but it doesn't have the chops to undo what #54 has brought down upon us.  So thanks, ACOG, for a great start.  What else have you got for us?

Extreme morning sickness

This article came across my screen this evening as I'm re-adjusting to life at home.  It tells the story of a woman who had such severe morning sickness during her pregnancies that she decided to terminate her second pregnancy because of the health and personal problems it was creating.

What she had was not your usual morning sickness.  Hyperemesis Gravidarum is a condition that is more than inconvenient or uncomfortable.  It is a serious disruption to a woman's health and life.

In my experience with clients diagnosed with HG, the nausea can be debilitating and have a serious impact on a woman's health and life.  Women who experience HG in one pregnancy often have the condition again in subsequent pregnancies and sometimes it gets worse with each pregnancy.

One of the key factors in successful treatment of HG is early, agressive intervention.  Treatment with acceptable anti-nausea drugs, maintaining hydration and vitamin/electrolyte balances through IV if necessary and bedrest and hospitalization at the earliest appropriate time can keep HG from becoming so debilitating that a woman's health is at risk.

Whether or not these measures were available to Mrs. Harrison is unclear in this brief article.  For a public health doula, the article is a poignant story about one woman's suffering that leaves many questions unasked about how terminating her pregnancy became the necessary step.  What does the public health care system in the UK do to screen early pregnancies?  What knowledge of treatments did the doctors have?  Was Mrs. Harrison advised of the importance of early intervention with her subsequent pregnancy?  Were she and her husband and daughter supported at all with family leave and child care options while she dealt with a debilitating medical condition during pregnancy?

Anti-nausea medications are expensive, maybe they weren't covered by her health care.  I know that has been an issue for my clients in the past.  I have absolutely no doubts about Mr. and Mrs. Harrison's ability to decide for themselves to terminate the second pregnancy.  I just think it would be a shame if something could have been done for her health before it became so compromised that the best solution was to terminate the pregnancy.  And I applaud Mrs. Harrison for speaking up and sharing her experience.  The more women give voice to their experiences with pregnancy and abortion, the less shame and shadow we have surrounding these parts of our lives.  She's right when she suspects that other women have terminated for the same reason but have kept silent because of the taboo.

I've only just returned from a 9 day vacation with my family.  The experience was fantastic, and has left me re-energized and ready to hop back into my work life.  It won't be another 3 months before I post again, I promise!

Re-certified

I just finished my recertification paperwork for my Lamaze Childbirth Educator and DONA International Birth Doula certifications.  This is the 3rd time I've recertified as a DONA doula and my first official re-cert with Lamaze.  I was pleased with how easy it was to do online continuing educaiton through the Lamaze member center.  I took two ethics courses worth one CEU hour each and they actually took me less than an hour to complete while being interesting, educating and thought provoking.

Here's to another 3 years as a birth junkie.

Internal Consistency

Today I was had a wide-ranging and interesting conversation with a woman who runs a local emerging non-profit organization.  Though the conversation was organizational development-this and capacity building-that, I realized that my explanations of how I could help the board grow the organization sounded a lot like my conversations with expectant couples and how I can help them be strong advocates and educated consumers of health care.

Internal consistency, in statistics and research tools, is the ability of a tool to measure or demonstrate a value consistently throughout.  It means that if someone answers a question one way in one question, they will answer a later question in a way that supports their previous position.  

I don't advocate for people, I teach them to and support them in advocating for themselves.  I can't take the burden of labor away from a woman but I can support her in finding her own strength to labor as she will.  Similarly, when working with an emerging organization, I don't tell them how to grow and develop their missions and programs, I help them articulate their collective passion and vision.

I realized today, happily, that though my work as a doula, public health professional, and even as a temporarily home-schooling parent, looks fragmented and random, it is actually very internally consistent with who I am, what I enjoy and what I'm good at doing.

What a lovely way to start a day.

Retired military leaders and public health officials have something in common.

News today from Mission: Readiness, 75% of American youth are too out of shape [read: obese] to serve in the military.

From their press release:

"Declaring that escalating rates of child obesity pose a serious threat to national security, retired military leaders joined Sen. Richard Lugar (R-IN) and U.S. Secretary of Agriculture Tom Vilsack today in support of new child nutrition legislation to help reduce the obesity epidemic and expand the pool of healthy young adults available for military service."

I agree.  Our nation needs soldiers fit to defend our borders and our interests.  We also need a healthy enough population that we will be able to compete in the global marketplace, create art, serve on juries, and raise families.

If what speaks to policy makers and the average American is that we need better food policy in order to get better soldiers, then I am all over it.  Because they aren't wrong and the policies and cultural changes necessary to create healthier 17-24 year olds will also create healthier <17 and >24 year olds too.

Prepared foods need to be healthier, we need to be able to eat fast and convenient food without getting 300% the RDI of sodium.  Poor communities need access to fresh food.  School lunches need to be healthier.  Fast food joints should put calorie counts up with the prices.  We need physical education in schools and bike paths in cities.

These things will make more American's fit to serve in our armed forces (shout out to my little brother the vet!).  And if we are fit enough to serve in the military, then we'll be fit enough to stand up for ourselves in democracy as well.

Wow, has it really been almost a month since I posted last?  Spring breaks were tough on my professional productivity and things are just starting to creep back into controlled chaos.  Plus, I need to stop thinking that I need to write novels and term papers for my blog.  I'm a blogger who doesn't know how to whip out a post, which makes me either a lousy blogger or a very green one.  Time will tell...