Moral Distress in Healthcare Workers

Hey, all.

As the semester comes to a close, I have reflected upon the material covered in this course. We have discussed various risk factors for birth, birth location, and cultural beliefs. Through our discussions, we have recognized the lack of resources in many regions of the world which contributes to the aforementioned topics. Furthermore, we have examined how inadequate supplies and resources affects the birth outcomes of the patients. However, we have not fully explored the idea of the relationship between the lack of resources and the healthcare workers.

According to “Moral distress in nursing practice in Malawi”, nurses experience high rates of moral distress from a variety of sources. For example, the moral distress stems from a shortage of staff members and a lack of resources, as well as mismanagement by superiors, behavior of colleagues, patients’ disrespect, and regulation violations. Furthermore, the article states, “Shortages of these resources meant that nurses cannot provide quality care thereby leading to frustration and demoralization,” (Maluwa 203). Therefore, the inadequate supplies affects not only the pregnant mothers but the healthcare workers as well.

As students in a “Birth and Global Health” course, I assume that many of us desire to pursue a career in a global context. Thus, we, as healthcare workers, will likely encounter situations in which the clinics, if one exists, do not have sufficient supplies. As a result, we may struggle with moral distress as well. Therefore, I pose the following questions to you all: How do you think the lack of resources will affect you? How would you cope with such effects, such as moral distress?

I aspire to pursue a career in humanitarian medicine. Thus, I anticipate that I will have to develop strategies to cope with the moral distress. For instance, perhaps physical activity or mediation may help me shift my focus onto what I can do rather than on the multitude of problems.

Maluwa, Veronica Mary, et al. “Moral Distress In Nursing Practice In Malawi.” Nursing Ethics 19.2 (2012): 196-207. Academic Search Complete. Web. 1 Dec. 2014.

Breast is Best?

Is breast best?

We have touched upon the highly controversial debate of breast milk versus formula, but we have not discussed the matter in detail. Thus, I want to provide the forum to share thoughts and opinions about breastfeeding a baby or formula feeding a baby.

Many argue that mothers should breastfeed their baby. To begin with, breast milk can improve the child’s health, for the mother passes antibodies from herself to the child through the breast milk. As a result, the child builds his or her immune system to help fight off infections. In addition, due to the nature of the breast milk, the baby digests the milk more easily than formula. Moreover, the act of breastfeeding benefits not only the child but the mother as well. For example, through breastfeeding, the mother can bond with the child, which can improve the mother’s emotional health. Although breastfeeding appears as an ideal option for feeding an infant, various problems exist. For instance, as we discussed on Monday, the mother can pass harmful chemicals or viruses through the breast milk as well. Thus, the breast milk could actually cause the child more harm than good.

Individuals argue the aforementioned point about transmitting substances to the child to promote the use of formula for feeding the child. For example, the formula would provide the child with the necessary nutrients without the risk of transmitting fatal viruses. In addition, the mother can consume anything that she wants or needs, such as alcohol or medication, without the fear of passing it along to her infant. Furthermore, formula-feeding would enable both parents to develop a bond with the baby, for both partners can feed with a bottle. On the other hand, however, formula-feeding presents obstacles. For instance, parents must pay for the formula, which may cause financial stress. In addition, a mother can access breastmilk at any time, limited by the debate over breastfeeding in public, but she must travel to the store to purchase formula.

Thus, with all of the aforementioned information in mind, what would you all recommend: breastfeeding or formula-feeding? I would argue that a simple answer does not exist. Personally, I would follow the American Academy of Pediatrics’ recommendation of feeding a baby breastmilk until the age of one year old. However, this recommendation alludes to the debate about the age at which a child should stop breastfeeding. Moreover, mothers who abuse drugs or alcohol should use formula instead of breastmilk to eliminate the risk of transmitting the chemicals in the substances to the baby.

Maternity Leave around the World

Hey, all.

We briefly touched upon the idea of maternal or family leave after childbirth in Cami’s presentation about Sweden. As she explained, Sweden implements a paid maternity leave policy for several weeks, something that we all envied. As a result, I decided to investigate the policies on maternity leave or parental leave around the world.

The first link shows an infographic for paid maternity leave in various countries. The following data really made an impression on me: Uzbekistan with 114 weeks, Mongolia with 156 weeks, Azerbaijan with 165 weeks, and Ukraine with 166 weeks. Due to the countries’ economic status within the world, I did not expect the aforementioned countries to implement such paid policies for multiple weeks. Furthermore, Finland surpassed all of the other countries with its policy of 167 weeks of paid maternity leave. Finland, a high-income country with a healthcare ranking of 31 according to the World Health Organization, offers an attractive maternity leave policy without compromising the economy or health care of the country, two common criticisms of paid maternity leave.

Unfortunately for us, not only does the United States rank lower on the health care list, but they also fail to provide paid maternity leave. According to the infographic, the United States offers ZERO WEEKS of paid maternity leave. This statistic confused me, for we discussed the maternity leave, minimal but existent, in the United States during Cami’s presentation. Thus, I inquired about the leave in the United States. During my research, I discovered the difference between our country and the rest of the countries in the world. According to the United States Department of Labor and the Family Medical Leave Act passed by President Bill Clinton, companies must provide employees with 12 WEEKS OF UNPAID maternity leave. Therefore, although the United States may offer more maternity leave than the Philippines (nine weeks paid) or the United Arab Emirates (six weeks paid), the latter two pay their employees unlike the United States. Thus, I pose the following question to you all: What influences the maternity or family leave policies in various countries? I believe that the culture in the United States contributes to the current policy in the country.

Over-the-counter Medications and Pregnancy

Raine’s presentation on illicit drug use and alcohol consumption during pregnancy intrigued me a great deal. However, I left the class wondering about the relationship between over-the-counter medications and pregnancy. Thus, I perused the literature and the internet to learn about various medications’ effects on the fetus.

As Raine explained, the mother passes chemicals to the fetus through the placenta. Therefore, some medications that may benefit a mother’s ailment has the potential to harm the fetus. As a result, the U.S. Food and Drug Administration has developed a system for categorizing medications based on their potential to cause birth defects to the fetus. As a way to filter the information for pregnant women, various sources have posted lists of “safe” medications to consume during pregnancy. The first link contains a table of such medications. For example, the website states that acetaminophen (Tylenol),  guaifenesin (Mucinex), and loratadine (Claritin) pose low risk to the fetus. Unfortunately, however, these websites may misguide pregnant women. According to the study in the second link, sufficient evidence and research on the medications’ harmless effects on the fetus does not exist. Therefore, the “safe medication lists” mislead women to believe that an increase in risk for birth defects will not occur. Furthermore, as shown in the third link, the Centers for Disease Control and Prevention also report that sufficient information on the relationship between medication consumption and birth defects does not exist, stemming from the lack of studies including pregnant women to test the safety of the medications. Thus, various credible sources criticize the “safe medication” lists floating around the internet.

The idea of internet sources or media misleading pregnant women reminded me of Raine’s discussion about the Cosmopolitan article that promoted alcohol consumption during pregnancy. As we discussed in class, a woman may read that article without further investigation and assume that she can consume alcohol during pregnancy. The same situation may occur with these “safe medication lists”, for women may not conduct additional research or read the fine print that explains that the over-the-counter medications on the lists may actually increase the risk of birth defects.

Birth in Prisons in Other Countries

Hey, all.

During my presentation, a few of you inquired about pregnancies in prisons in other countries. Thus, I conducted some research on the treatment and outcomes in other systems. While perusing the literature, I came across some intriguing articles. Although I could not determine whether or not the prison systems in other countries operated comparably to the state prison system in the United States, the treatment of and outcomes for the pregnant prisoners appeared rather similar.

To begin with, I discovered a powerful article about shackling. The first link tells the story of Meriam Ibrahim, a Sudanese woman. She claims that she gave birth to her daughter while shackled to the floor of a prison. As a result, the child may suffer from various disabilities. Although the United States’ prison system does not require a woman to give birth shackled to the floor, the majority of the states do not have policies that prohibit shackling during labor and delivery. Thus, I pose the following question: Should the United States implement the same practices as a war-torn, developing country?

In addition to treatment during labor and delivery, I researched information on the postpartum period. The second link discusses residential childcare programs in the United Kingdom, as shown in Washington State for example. It states that the United Kingdom allows women to raise their children in special units as well. However, the prisons only accept children up to eighteen months of age to live in the “mother and baby” units, with the exception of one prison that prohibits children greater than nine months old. Furthermore, it appears that the child does not have to be born in the prison.Thus, the mother can raise her children (up to eighteen months old) from her life before incarceration in the programs as well. Again, this scenario raises the same question from my presentation. Should a child suffer for his or her mother’s crime? Even though the mother has parental rights, should a child be confined to the walls of a prison (especially if a relative could raise the child)?

Due to the similarities between the United States’ prison programs and the United Kingdom’s prison programs, I chose to research the birth outcomes of incarcerated women in the UK. The last link leads to an article in the Lancet that compares the birth outcomes of incarcerated women and women on probation. The study reports that the prison experienced 669 live births and 6 stillbirths. On the other hand, the women on probation only had 426 live births and 12 stillbirths. Thus, the women in prison had a higher percentage of live births, better outcomes, than the women on probation. As speculated in my presentation, the study concludes that the greater outcomes stem from the cessation of alcohol and drugs and greater access to healthcare among populations of similar socioeconomic status.