Absolutely contradictory: "Pro-Life" and Anti-Medicaid Politics

     I have to be perfectly honest: I've never been a fan of politics.  I don't like debating, I don't like making people angry with my opinions, and I absolutely hate when I feel like my values are disrespected.  So since I was quite young, I've vehemently avoided open political commentary.

     Consider this me stepping out of my comfort zone, and speaking out on my local senatorial race for multiple reasons.  The most important of which is that I have met both Democratic and Republican candidates, in very different and informal ways.  One was briefly my neighbor, and the other was briefly my doctor.  I can't imagine a stranger scenario happening, especially to someone as young, politically-avoidant, and insignificant as me.  

     I'll be perfectly candid again--I've considered myself a Democrat for my entire adult life.  The reasons are mostly social, somewhat fiscal, but I am just so radically accepting of so many people's choices that I could never be labeled a Republican. I have friends in all walks of life, from a Microsoft employee making a six figure income to the polyamorous family with four children to the single mom of two who recently became aware of the necessity of programs like TANF and WIC (when she had previously identified as a Republican.)  Normally when I vote, I do a little skimming of the main issues, but it's mainly perfunctory, because I vote Democrat probably 80% of the time, unless I really like an Independent candidate.

     This year is different.  The Democratic candidate in my state is a career politician, who's been involved in multiple scandals, been convicted multiple times for a variety of offenses, and when he was my neighbor?  He just gave me a bad feeling in my stomach.  It doesn't truly matter to me about his personal life, or his illegitimate children, in view of his political values being consistent with mine.  However, knowing that he fathered a child with his young secretary makes me wonder if he shouldn't be more aware of power dynamics, and how that could be easily viewed as a gray area to many.  It's futile to elect someone who is at risk of losing their position related to further scandal.

     I didn't come here to talk about the Democratic candidate, though.  It's the conservative platform of the GOP candidate that made me so very upset today.  What first caught my attention was a friend's post on Facebook (of all places!) about a new commercial that my old obstetrician has aired locally.  Her website talks about how her mother raised her to be aware of her privilege, and to take care of others subsequently.  She uses this to say that she supports veterans, but then turns around and says she is against Obama-care and the expansion of Medicaid.  Of course, she is running, touting the misnomer of "Pro-Life" as well.

     Since she is an obstetrician, this is where my brain was absolutely boggled.  Medicaid provides obstetric and prenatal care to so many under-privileged women, and continues to provide medical care to the children after delivery.  If you want to get technical, forty eight percent of all births in 2010 were covered by Medicaid (or CHIP, a related, federally funded program) in 2010 (Markus et al., 2013).  In my profession, I see many, many patients who are covered by Medicaid, who would not be able to seek medical care otherwise.  The idea of denying the poor women of our state,  potentially even half of the women who bear children here, desired abortions because they are not congruent with her personal beliefs, and then deny them subsequent prenatal care for the child that they are being forced to bear?  


Forty eight percent of all births in 2010 were covered by Medicaid.



     This is unconscionable, unacceptable, and not what the women of my state deserve.  It's not what the poor deserve, and it's not aligned with how this woman presents herself.  She talks extensively about supporting veterans, but let's be realistic: veterans are a minute group compared to those of lower economic status.  I am a veteran, and I appreciate when politicians acknowledge the burden of combat veterans, but it does not mean that other poor or underserved persons do not matter by comparison.  The fact that it is an obstetrician running on this platform oozes of greed and judgment: Medicaid patients may pay her less at her practice, if she even takes them as patients.  Apparently her idea of 'empowering women' is denying them choices of what to do with their bodies?  If they don't have enough money, they don't deserve the care to ensure a healthy pregnancy and infant?  It seems like the only women who should be having sex are those with plenty of money, because otherwise you don't deserve to choose not to be a mother.  Heaven forbid, you're poor and have a birth control failure--you're just out of luck.  This smacks of the sexual policing of women, and is disgusting.  It is a fact that the advent of the control of reproductive function, through birth control and abortion, have contributed to the improved state of women in society.  They attain higher levels of education, improved economic security, and better control the size of their families (Frost and Lindberg, 2013).  

     It's beyond ironic that a female doctor who specializes in female health is advertising this rubbish.  In fact, it's not ironic, it's depressing.  And also a little bit galvanizing, getting me back into politics, even if it's just for the next few months.




References

Markus A. R., E. Andres, K.D. West, N. Garro, and C. Pellegrini. (2013). Medicaid covered births, 2008 through 2010, in the context of the implementation of health reform. Women’s Health Issues, vol. 23, no. 5, 2013, pp. e273–e280. 

Frost, J. J. and Lindberg, L. D. (2013). Reasons for using contraception: Perspectives of US women seeking care at specialized family planning clinics. Contraception, vol. 87, issue 4, 2013, pp 465-472.

Married with Children... And Mental Illness

     It is with a burgeoning awareness that our culture acknowledges perinatal mental illness. Postpartum depression is given far more credence today than it was in decades past--as it should be, considering an estimated 9-16% of mothers are affected.  The burden of this condition is becoming common knowledge, which is both commendable as well as overdue.

     It is no surprise to anyone who has been through postpartum depression, or any other serious mental illness, that the condition places stress on many interpersonal relationships. The most important of which, during the postpartum period, being that relationship between the mother and her significant other. A significant correlation has already been noted between several psychiatric conditions and divorce--it is not unrealistic to state that a postpartum mood disorder would similarly strain a marriage or partnership.

Postpartum Depression Fathers postpartum depression

     Parenthood carries many extra stressors for relationships--sleep deprivation, decrease in disposable income, decrease in time for leisure activities, altered relationships with peers without children, and massive change in daily routine being the first that come to mind. The impact these factors alone could have on a marriage, not even to add on the burden of decreased functioning and mood from PPD, is immense.

     Mothers may carry the burden of the depression, but rarely is the experience of the partner mentioned. I think this does a disservice to the marriage, the partner, and the mother, as well as the family as a whole. A family is a complex, ever-evolving machine. The parents complement each other, creating a protective, insular bubble of support for the children. When the mother experiences PPD, she may withdraw, enjoy her life, children, or partner less, or even contemplate suicide. This places the partner in a position to provide care not only to the children, but also to the affected mother. Imagine if the partner also works outside the home while the mother is home during the months postpartum, and the stress this may cause by being the sole source of income while also being required to emotionally be present extra at home.

     Taking this all into account, it's no surprise that PPD and other perinatal mood disorders could increase the chances of divorce. Marriage takes work and purposeful navigation, even when it is a strong, healthy marriage. When one partner is suffering, the other partner needs extra social support to carry the rest of the family. This social support may 'hold up' the partner while the partner 'holds up' the mother and other children while acclimating to the newborn.

     I'm a big supporter of in-home care.  I've experienced the significant difference it can make, to have an experienced, kind healthcare provider who comes to you in your home.  With my second son, I delivered him with an nurse-midwife in attendance, who continued to visit us in home until we had resolved my breastfeeding issues.  She also spoke with me frequently over the phone, keeping a close eye on me, as I suffered from PPD with my birth of my first son.  I feel like it made a huge impact on my physical recovery, as well as my processing of my birth and avoidance of a recurrence of PPD. 

     Developing this sort of long-term relationship with a family is the kind of care that cannot be accomplished with the current model of revolving door providers, especially with how difficult it may be for these families to commute to an office.  Traveling with an infant is hard.  Being depressed, or anxious, or hormonal, and being on time to another location to deal with more people is too much work for many mothers affected by PPD or other mental illness.  In-home care, combined with one or two consistent providers who are available by telephone for the whole family would be a huge addition to our healthcare system.  Maybe this niche could be filled by a variety of providers--midwives, psychiatric nurse practitioners, licensed clinical social workers, therapists, or even registered nurses with special training in postpartum mood disorders and case management.  Any of these professionals would be able to help, by listening to a stressed spouse, the affected mother, or even helping with appropriate referrals as necessary.  It could be a huge step towards addressing a gap in our social support system as well as our medical system.

     Families truly deserve to be 'met where they are' with their care.  If a family is struggling, it makes sense that the healthcare system should come to them.  The risks of not doing so are too high, as untreated postpartum depression can have lasting effects on the relationships within the family, as well as the development of the children therein.  An improved model of care could provide the temporary support these families need to hopefully avoid divorce and further suffering related to PPD, and help our society as a whole.



References

American Psychiatric Association. (2015). Postpartum depression.  Retrieved from http://www.psychiatry.org/postpartum-depression/
National Association for Mental Health. (2015). Women and depression: Postpartum depression. Retrieved from http://www2.nami.org/Content/NavigationMenu/Mental_Illnesses/Women_and_Depression/Post-partum_Depression_Fact_Sheet.htm
Centre of Perinatal Excellence. (2014). Managing stress in early parenthood. Retrieved from http://cope.org.au/first-year/managing-stress/

Photo credit: http://www.naturamagazineusa.com/wp-content/uploads/2013/10/postpartum_depression.jpg

Parenting after Sexual Abuse: Talking about Sex and Protecting Our Young

     There's definitely been a theme of my writing lately, to where I'm drawn to writing about survivors of sexual trauma.  It's a problem that I've become increasingly aware of, on many different fronts and in many different ways.  One of the lesser mentioned ways may be the impact on our parenting.

     For some perspective, estimates on the number of Americans who are victims of sexual abuse state that someone is sexually assaulted every 107 seconds.  That's a a high number, but the sad fact is that this is an improvement.  From 1993 to 2013, the national rate of sexual assaults decreased by 49%--which is a really steep decrease.  The idea that 4.2 million Americans were sexually assaulted in the past 20 years, however, is staggering.  Nauseating.  Horrifying.  

     One of the impacts that is often left out of this conversation is how this affects how survivors speak with their children about sex.  Although many parents report having held a version of 'The Talk,' research shows that what conversations parents do have with teenagers are often too little and too late.  Many of the complex emotions that the parent may attribute to young people having sex may stymie necessary conversations about consent, bodily autonomy, and other topics that anatomy- and abstinence-focused sexual education programs in school omit.  

     The question then remains: How do we talk about sex with our children without passing on our fears that they may also be abused?  How do we address issues related to abuse without triggering ourselves?  How much do we disclose about our abuse to our children?

Protecting our children is one of society's greatest responsibilities

     There is no road map to parenting after abuse.  In fact, the stigma attached to men who have been assaulted may prevent them from ever disclosing abuse or discussing the possibility with their sons.  The reality is that rape and sexual assault do not only happen to women, and that sons need to be spoken to as well as daughters from a young age about appropriate touch and consent.  The illusion that our sons are immune to being violated is exactly that--an illusion.

     Before you stop reading because of all the doom and gloom above, I want to reinforce that I do consider myself to be sex-positive.  Consenting sex between any two competent individuals is great.  Sex can be healing, spiritual, fun, romantic, and a host of other wonderful things.  I just know that I struggle with how I will present that dichotomy to my sons, as some of my earliest sexual experiences were not any of those things.  How do I encourage their caution without overly inhibiting their natural sense of curiosity as they enter puberty?  I don't want to terrorize them.  I don't want them to be paranoid or damaged because of my baggage.  But I also want them to be safe.  I want them to be responsible (for teenagers.)

I know, I know.  It's a lot to ask.


References:
U.S. Department of Justice. National Crime Victimization Survey. 2009-2013.

U.S. Department of Justice. National Crime Victimization Survey. 1993-2013.
Rape, Abuse, & Incest National Network. How often does sexual abuse occur? https://www.rainn.org/get-information/statistics/frequency-of-sexual-assault
Hyde, A., Drennan, J., Butler, M., Howlett, E., Carney, M., Lohan, M. (2013). Parents' constructions of communication with their children about safer sex children about safer sex. Journal of Clinical Nursing, (EPUB ahead of print).
Image: http://images.essentialbaby.com.au/2009/09/18/739583/Protect-child-mother_420-420x0.jpg

Motivated by Emotion

I have a confession: I have always been fascinated by human emotions and relationships.  My earliest training, if you will, was in theatre.  I was graced with entry into a local high school with an arts program that raised up many, many creative people, some of which went on to work in the arts.  The others went on to bring their experiences with art to other things.  I obviously belong to the latter category!  

After my experience in theatre, I spent a year abroad.  I will say that this honestly taught me more about culture than emotions per se, but they share many common themes, and thus are interrelated.  I soaked up foreign television, watched interesting interpersonal exchanges with a perhaps excessive interest, and generally soaked up every drop of  'people' I could. I learned probably as much about others as I did about myself that year.




And returning home I learned even more.  I was inspired to become an EMT and volunteer with my local rescue squad (the precursor to my nursing career!) as well as suffered an immense bout of reverse culture shock.  This phenomenon is characterized by the cognitive dissonance of difference between our expectation of home versus how we experience it once we return.  It is both jarring and difficult to address, on an intra- and inter-personal level.  I found myself feeling guilty that I so strongly disliked certain aspects of Americanism, as if I was a 'bad' American--or if I had become, instead, more African than American (gasp! I did honestly feel this way--for months.) 

Many of these feelings I stumbled through, as I was only 17 and still immature.  It was hard for me to reconcile these new parts of me, and attitudes.  Africa was not the most liberal of environments, and yet I felt African and identify as bisexual.  This felt absolutely contradictory at the time.  Living in a home with close to thirty people had left me craving domestic tranquility in the form of seven--yes, you read that correctly--children (any parent will agree that this is impossible) and yet I was still only 17, on birth control pills, and not ready for marriage to my high school beau.  (Thank goodness for THAT foresight.)  I was caught in a cultural purgatory that my biological parents and peers were mostly unable to understand, much less help with.  I had complicated feelings about my sexuality resulting from the African emphasis on virginity, sexual restraint, and necessity of marriage that I don't think I really shook for the better part of a year.  This was a lot of big concepts for someone to wrap their brain around, while approaching the wise (/sarcasm) age of eighteen.

The next turn in my career was law enforcement.  Incidentally, this path brought me face-to-face with people experiencing many of the most raw emotions, specifically fear and anger.  It was primal and whenever I felt like I helped, I was incredibly happy.  However, the gratitude-to-helping ratio in this profession is dismal, so it was not a great path for me in the long run.  I joke with people that I am like a Hooters waitress: I am flattery operated. (Because feelings-operated does not have the same ring to it.)

This is why I think I am so drawn to nursing as a whole.  Feelings and gratitude are my bread and butter.  Of course, I take care of medical needs, and this is essential, but I love my emotional connections with the women and families that cross my path.  I love holding hands and rubbing backs and witnessing them evolve.  I'm paid to be emotionally involved with many people, and it is honestly incredible.  I love being a nurse, even when it is messy and strange and sad, but especially when it is inspiring.