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Home Based Life Saving Skills

In our nursing program, we learn about the many ways a nurse can intervene when something unexpected occurs during a birth or a pregnancy.  For example, we learn to what instruct women to do when they call our office and note they have not felt fetal movement in a while (perhaps via phone triage).  Also, we learn different methods to alleviate bleeding/hemorrhage after delivery of a baby (like uterine massage).

I really appreciated Dr. Sibley’s Home Based Life Saving Skills talk because it is a simple way to reiterate all the nursing interventions we’ve learned and can utilize when things go left.  The pictures are phenomenal.  I was speaking with Val, and she showed me that these picture booklets are downloadable online (see below).  I really wish I had access to these last year because it would have helped with my care plans and my knowledge.  These skills are not only applicable in the home; they are applicable in any situation and includes the hospital and/or birth center.

It’s really amazing that these nursing interventions I learned are actually just “interventions” without the “nursing” because there is nothing special about them or unique to a nurse with a license.  It’s about being aware about what is happening and when you really need to see a professional.  These HBLSS empower women, families, and the community.  Dr. Foster, you should definitely introduce this website and or booklet(s) to the students in your next Developing Families course.  I think it helps bring things full circle, and there are many non-invasive, non-pharmacological ways to handle potential emergency situations.  Just pee or massage or breastfeed!

Here in the US, I know people take birthing classes on a variety of topics, but HBLSS information should be available (or taught) to people as well…although I don’t know how likely someone will remember information in a crisis or almost-crisis situation.  I can see if being helpful to teach in those American Indian communities that are far from facilities.

There are multiple editions of HBLSS on the website.

American College of Nurse-Midwives.  (2014).  ACNM Publications.  Retrieved from http://www.midwife.org/ACNM-Publications


Family Planning Programs

I want to discuss more about this globally, and maybe someone does have more information from other countries, but there is a relationship in what I’m about to say.  It is also very related to what Val and I presenting on in another class.

Refugees and immigrants come from all over the world to seek asylum or live in the US.  They come here, have limited funds, no health insurance, and have limited access to family planning.  But…they still have sex, of course!  Depending on who your partner is, this can sometimes lead to an unintended pregnancy.  This person can also be an American teenager or a working underinsured 20-something year-old.

I think I mentioned during Alyssa’s presentation about AWESOME family planning coverage in Washington State.  Here is more info on that Take Charge program:  http://www.kingcounty.gov/healthservices/health/personal/insurance/takecharge.aspx

There is also something AWESOMELY similar in California that is called Family Planning, Access, Care, and Treatment (FPACT).  http://www.familypact.org/_Resources/Tip%20Sheets/FamilyPACTOverview_V07-12ADA.pdf

In both cases, if this refugee/immigrant goes into, for example, a Planned Parenthood…the person behind the counter will assess their ability to pay and see if they qualify for Take Charge or FPACT.  This really does help the people who need help to pay for these types of important services.  Both are I don’t know everything, however, so I don’t know what happens when people don’t qualify…

Now…how can we get people from their new abodes to places where they can apply for these plans BEFORE they have an unintended pregnancy?  I don’t remember the citizenship requirements for Take Charge–been too long since I’ve been there.  For FPACT, however, you just have to be a resident of California in the sense of living there for “a few weeks” according to this one employee at the of the PP locations.  That was pretty neat to me that she did not ask for any state-issued ID or even federal-issued ID.

Do you know of any other programs domestically or globally that help fill this gap for people?

Black Women’s Wellness

Kind of similar to how the Center for Black Women’s Wellness went to the community, spoke to women, and figured out what their needs were…

My co-worker is starting to talk to Black women about what kind of services they want to see at the Feminist Women’s Health Center.  Below are some cards.  Some dates have passed–sorry.  BUT if you want to get involved, definitely contact her!  Her name is Park.  Email:  parkc [at] feministcenter [dot] org

I am not sure if she is working with the Center for Black Women’s Wellness or what, but I can find out.

Please pass on to anyone you know who might be interested in helping, participating, giving input!

BWW Post Card Final

BWW Brochure Final

Kangaroo Care, Fathers, Adopted Children

You know how sometimes you are presented with information and all you can think about is how that would apply to a certain situation?  Anyway, I was thinking about a million things during Molly’s presentation today.  When I first learned about Kangaroo Care, I don’t think I ever heard of the term with the word “Mother” inserted in it.  I did see/hear it tonight, though, and I was trying to figure out why it was there.  I remember my video introduction to KC had a dad involved.  But a dad has no role in maternal-fetal attachment.  Also, it’s out there written in both ways.  I think it is important to include fathers as stakeholders as well since birth does not exist in a vacuum (if fathers are present in the picture, of course).  I wouldn’t want that dad from the video to feel left out in Kangaroo Care.

THEN my mind wandered to attachment with adopted children (someone I know= adopted to American family from S. American country, pre-term birth), maternal-fetal attachment, and Kangaroo Care.  Attachment is tricky in this case…with whom should the fetus/baby be attached to?  The mama that provides the physical environment in which the baby grows (womb mama)?  The mama that will raise the baby (home mama)?  Perhaps the right answer is the *medium* answer–both.  Reasons?  I can think of reasons for both, but I’d like to see/hear what y’all think.

~2 page case study below.  Father involved, but that’s not the main point.  I suspect this is an American case given the name of the journal, but I can’t be sure.  This sounds all gravy and such, but what about the child who is born in South America pre-term at 30 weeks?  These parents had the luxury of being 15 hours away and kind of being “on call” regarding the birth.  What if his parents who live in Miami can’t get there to South America as quickly as the family in the article did due to sheer distance, job logistics, etc.?  Delayed Kangaroo Care by adopted parents is probably better than no Kangaroo Care, but it would be interesting to see if there is a significant difference between delayed KC and ASAP KC (by either biological or adopted parents).  Also, would it be fair/ethical to ask the biological mother to provide KC to this baby that she has already decided to put up for adoption until adopted parents arrive?

KC can be very important for pre-term babies, critically ill babies, and adopted babies and maybe doubly so for pre-term adoption babies (triply for pre-term, critically ill, adopted?).

Kangaroo Care and Adopted

Parker, L. & Anderson, G. C.  (2002, July/August).  Kangaroo Care for Adoptive Parents and Their Critically Ill Preterm Infant.  American Journal of Maternal/Child Nursing 27(4), 230-232.


Uruguay–Abortion Decriminalized, Now What?

In Kayley’s presentation a few weeks ago, we discussed all the different barriers to abortion.  In some countries and states, abortion is legal, or decriminalized in Uruguay’s case, but not without barriers.  Some barriers include limiting training for providers, cost, age requirements.

Yonah’s presentation regarding decriminalization of first trimester abortions in Uruguay made me think about what we sometimes take for granted here in the US.  While much of our government here in the US and Georgia is trying to restrict women’s reproductive freedom, Uruguay seems to be going the opposite direction slowly.  Barriers Yonah mentioned include requiring 4 visits for an abortion.  I can’t remember if this was medical or surgical, though.  In the US, it is typically 2, sometimes 3, visits–one or two for the procedure, one for a follow up.  Although I am happy to see that it is decriminalized, it makes me sad to hear there are still barriers.

What should reproductive freedom fighter Uruguayans focus on next?  Should they focus on expanding abortion services to a later gestation (second trimester)?  OR should they focus on breaking down current barriers for this first trimester abortion?  Obviously, real life has many shades of gray and is not an either/or situation.  If I had to choose one main focus, I would probably focus on breaking down current barriers.  Once a first trimester abortion becomes more of a surgical or medical procedure and less of a moral action, then maybe activists can begin to convince people that second trimester abortions can head the same way.

Here is a good short, less recent piece on Uruguay that I found:  http://popdev.hampshire.edu/projects/dt/77

Role of Mobile Clinics

We’ve touched on utilizing mobile clinics a few times in the course.  For the most part, we discussed it in a US context, but this could hold true for other areas of the world that have the quality of infrastructure that is required for an automobile.

In Beatrice’s presentation, we talked about utilizing mobile clinics on the reservation for American Indians.  The wide and vast acres of land in AZ may require providers to meet women in their location for prenatal visits.  An Emory alumna once told me that she likes to “meet patients where they’re at”.  She meant this in terms of knowledge about their health, but I think this is equally as important in the literal sense.  In Eric’s presentation of urban vs. rural care, we saw that mobile clinics can be helpful as well.  I believe the example we saw was primary care provided to a rural W. VA community.  In our MCH Safe Motherhood Malawi example, it was important for the nurse to gather in the village so the women could ask questions.  Another example of mobile clinics–my best friend from college does breast screenings on a bus that also provides mammograms to women in 4 boroughs of NYC.  In all these cases, you are bringing necessary care to the people that need it.

With respect to birth, I think prenatal visits are completely feasible and realistic for these American Indian populations or anyone else who may live in a very rural area.  Similar to what we saw in Eric’s video, the visits can include disbursement of medication like prenatal vitamins and such.  Mammogram and screening type appointments are also appropriate.  What is the solution, though, when a woman gets further along in her pregnancy?  What if complications occur between visits?  Whose responsibility is this/shoulders does this fall on?  In our society of finger-pointing, I think having mobile clinics can actually be very risky.  I would hate to see the provider saying s/he left the woman in good condition and the woman saying why didn’t s/he catch this problem when s/he saw me?  Also, what if the mobile clinic is bringing important medications to people and doesn’t make it out to the community for some reason?  That can be life-threatening.  I know IHS currently only collaborates with certain pharmacies, but perhaps getting a contract with a company like Express Scripts who delivers to the door might help and decrease gaps in medication.

Obviously, the best idea would be to build a clinic in these communities and convince healthcare providers to be there 2-3 or even 5 days a week, but what can we do in the interim that is not so risky?  And in the interim with our mobile clinic prenatal visits, what would happen when it comes time for a woman to deliver?  I’d like to see what people think out there, because I have been contemplating on this for weeks now and still haven’t brainstormed of any good ideas.